Healthcare Provider Details

I. General information

NPI: 1174720619
Provider Name (Legal Business Name): ALEXANDER TAN VILLACASTIN ARNP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/28/2007
Last Update Date: 10/17/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10489 N FLORIDA AVE
CITRUS SPRINGS FL
34434-3268
US

IV. Provider business mailing address

10489 N FLORIDA AVE
CITRUS SPRINGS FL
34434-3268
US

V. Phone/Fax

Practice location:
  • Phone: 352-489-2486
  • Fax: 352-489-5786
Mailing address:
  • Phone: 352-382-8282
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberARNP2986862
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: