Healthcare Provider Details

I. General information

NPI: 1093309288
Provider Name (Legal Business Name): DAILI CASTELLANOS SANTOS NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/27/2021
Last Update Date: 04/17/2026
Certification Date: 04/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

99 MAGNOLIA AVE
AUBURNDALE FL
33823-4301
US

IV. Provider business mailing address

5272 KRENSON WOODS WAY
LAKELAND FL
33813-6601
US

V. Phone/Fax

Practice location:
  • Phone: 863-967-4451
  • Fax:
Mailing address:
  • Phone: 786-406-3163
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number11011581
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number11011581
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: