Healthcare Provider Details

I. General information

NPI: 1063285773
Provider Name (Legal Business Name): MARITZA CASTILLO ALFONSO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/03/2023
Last Update Date: 04/14/2026
Certification Date: 04/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

888 S PARSONS AVE
BRANDON FL
33511-6007
US

IV. Provider business mailing address

6822 W WATERS AVE
TAMPA FL
33634-2212
US

V. Phone/Fax

Practice location:
  • Phone: 813-697-1888
  • Fax:
Mailing address:
  • Phone: 813-280-4909
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number11029710
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: