Healthcare Provider Details

I. General information

NPI: 1982147013
Provider Name (Legal Business Name): STEPHANIE CASTILLO FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: STEPHANIE CASTILLO FNP-C

II. Dates (important events)

Enumeration Date: 11/21/2016
Last Update Date: 06/28/2022
Certification Date: 06/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1250 S CLEARVIEW AVE STE 100
MESA AZ
85209-3378
US

IV. Provider business mailing address

1250 S CLEARVIEW AVE STE 100
MESA AZ
85209-3378
US

V. Phone/Fax

Practice location:
  • Phone: 480-423-4670
  • Fax: 480-654-2922
Mailing address:
  • Phone: 480-423-4670
  • Fax: 480-654-2922

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP9593
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: