Healthcare Provider Details

I. General information

NPI: 1649883760
Provider Name (Legal Business Name): KATHLEEN CASTILLO APRN, FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/28/2020
Last Update Date: 09/29/2026
Certification Date: 09/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550 BILTMORE WAY STE 101
CORAL GABLES FL
33134-5779
US

IV. Provider business mailing address

640 E 57TH ST
HIALEAH FL
33013-1356
US

V. Phone/Fax

Practice location:
  • Phone: 305-424-5775
  • Fax: 786-288-3595
Mailing address:
  • Phone: 305-609-5428
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number11051203
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: