Healthcare Provider Details

I. General information

NPI: 1831027697
Provider Name (Legal Business Name): ROBERTO CASTILLO MACAIRAN APRN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/12/2026
Last Update Date: 05/12/2026
Certification Date: 05/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 HIGHWAY 466 STE B101
LADY LAKE FL
32159-3925
US

IV. Provider business mailing address

PO BOX 658
FRUITLAND PARK FL
34731-0658
US

V. Phone/Fax

Practice location:
  • Phone: 352-633-7649
  • Fax: 352-633-7694
Mailing address:
  • Phone: 352-633-7649
  • Fax: 352-633-7694

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License NumberAPRN11047176
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: