Healthcare Provider Details

I. General information

NPI: 1942830633
Provider Name (Legal Business Name): ERIK JOSEPH CASTELLANO CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/22/2020
Last Update Date: 06/08/2020
Certification Date: 06/08/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 S ANDREWS AVE
FORT LAUDERDALE FL
33316-2510
US

IV. Provider business mailing address

190 SE 5TH AVE APT 524
DELRAY BEACH FL
33483-5284
US

V. Phone/Fax

Practice location:
  • Phone: 954-355-4400
  • Fax:
Mailing address:
  • Phone: 954-812-0979
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License NumberRN9363991
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number11007424
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: