Healthcare Provider Details

I. General information

NPI: 1003175126
Provider Name (Legal Business Name): JOHANA BEATRIZ CASTRO WAGNER M.D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/09/2012
Last Update Date: 12/07/2025
Certification Date: 12/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11200 SEMINOLE BLVD STE 310
LARGO FL
33778-3239
US

IV. Provider business mailing address

PO BOX 917770
ORLANDO FL
32891-0001
US

V. Phone/Fax

Practice location:
  • Phone: 727-397-8557
  • Fax: 727-397-4459
Mailing address:
  • Phone: 813-821-8038
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0201X
TaxonomyPediatric Allergy/Immunology Physician
License NumberME124372
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: