Healthcare Provider Details

I. General information

NPI: 1194778647
Provider Name (Legal Business Name): ETNA M CASTELLANOS APRN/DC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ETNA M CASTELLANOS ARNP

II. Dates (important events)

Enumeration Date: 05/18/2006
Last Update Date: 03/03/2022
Certification Date: 01/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1176 SW 67TH AVE
MIAMI FL
33144-4700
US

IV. Provider business mailing address

1354 SW 18TH ST
MIAMI FL
33145-1634
US

V. Phone/Fax

Practice location:
  • Phone: 305-359-9838
  • Fax: 786-224-6549
Mailing address:
  • Phone: 954-702-4518
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberARNP9346434
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCH 7185
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: