Healthcare Provider Details

I. General information

NPI: 1083399232
Provider Name (Legal Business Name): JACLYN THERESA CASTELLI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2023
Last Update Date: 07/04/2023
Certification Date: 07/04/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

425 S HUNT CLUB BLVD STE 1051
APOPKA FL
32703-2428
US

IV. Provider business mailing address

402 OAK LYNN DR
ORLANDO FL
32809-3047
US

V. Phone/Fax

Practice location:
  • Phone: 407-786-4080
  • Fax:
Mailing address:
  • Phone: 813-416-8540
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN11027060
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code163WM0102X
TaxonomyMaternal Newborn Registered Nurse
License Number9443137
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: