MEDICARE: TAYLOR CASTELLANO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	9315008	FL
2	363L00000X	Nurse Practitioner	APRN9315008	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1376047134
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TAYLOR CASTELLANO

Provider Business Mailing Address
First Line	:	900 S PINE ISLAND RD STE 800
Second Line	:
City	:	PLANTATION
State	:	FL
Zip	:	33324-3923
Country	:	US
Telephone Number	:	954-967-6400
Fax Number	:	954-337-5755

Provider Business Practice Location Address
First Line	:	PEDIATRIC ASSOCIATES
Second Line	:	317 S. DIXIE FREEWAY
City	:	NEW SMYRNA BEACH
State	:	FL
Zip	:	32168-7158
Country	:	US
Telephone Number	:	386-424-1414
Fax Number	:	386-424-9130

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/19/2018
Last Update Date	:	03/29/2024

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Directions to “ TAYLOR CASTELLANO ” Practice Location

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