Healthcare Provider Details

I. General information

NPI: 1194473017
Provider Name (Legal Business Name): ANNA NICASTRO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/10/2022
Last Update Date: 07/26/2026
Certification Date: 07/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8315 PARK BLVD APT 4413
MIAMI FL
33126-8048
US

IV. Provider business mailing address

8315 PARK BLVD APT 4413
MIAMI FL
33126-8048
US

V. Phone/Fax

Practice location:
  • Phone: 786-488-5825
  • Fax:
Mailing address:
  • Phone: 786-488-5825
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-24-73014
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT20118112
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: