Healthcare Provider Details

I. General information

NPI: 1992419840
Provider Name (Legal Business Name): OLIVIA CATHERINE CASTELLONE PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/05/2023
Last Update Date: 12/06/2024
Certification Date: 12/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13685 DOCTORS WAY STE 100
FORT MYERS FL
33912-4337
US

IV. Provider business mailing address

PO BOX 2147
FORT MYERS FL
33902-2147
US

V. Phone/Fax

Practice location:
  • Phone: 239-343-1612
  • Fax:
Mailing address:
  • Phone: 239-343-1612
  • Fax: 239-343-4229

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA9119396
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: