Provider Demographics
NPI:1992001861
Name:CECKA, MEGAN (PA-C)
Entity type:Individual
Prefix:MS
First Name:MEGAN
Middle Name:
Last Name:CECKA
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 1:621 VICTORIA ST
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:FL
Mailing Address - Zip Code:33510-4313
Mailing Address - Country:US
Mailing Address - Phone:813-655-0292
Mailing Address - Fax:
Practice Address - Street 1:621 VICTORIA ST
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33510-4313
Practice Address - Country:US
Practice Address - Phone:813-655-0292
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-02-09
Last Update Date:2024-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2643-023363AM0700X
FL9107337363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL009175700Medicaid
WI2643-023OtherSTATE LICENSE
WI1088923OtherNCCPA
WI1088923OtherNCCPA