Healthcare Provider Details

I. General information

NPI: 1710803580
Provider Name (Legal Business Name): TIMOTHY ALLEN NICASTRO JR. DNP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/26/2026
Last Update Date: 06/26/2026
Certification Date: 06/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1765 RIDGE AVE
DAYTONA BEACH FL
32117-1731
US

IV. Provider business mailing address

1765 RIDGE AVE
DAYTONA BEACH FL
32117-1731
US

V. Phone/Fax

Practice location:
  • Phone: 386-212-4212
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: