Provider Demographics
NPI:1427685007
Name:CELLINI, TATIANA CECILIA (PA-C)
Entity type:Individual
Prefix:
First Name:TATIANA
Middle Name:CECILIA
Last Name:CELLINI
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2001 MERIDIAN AVE APT 422
Mailing Address - Street 2:
Mailing Address - City:MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33139-1543
Mailing Address - Country:US
Mailing Address - Phone:954-548-4925
Mailing Address - Fax:
Practice Address - Street 1:2320 NE 62ND ST
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33308-2208
Practice Address - Country:US
Practice Address - Phone:954-500-3376
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-24
Last Update Date:2023-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9116963363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant