Healthcare Provider Details

I. General information

NPI: 1558074468
Provider Name (Legal Business Name): CATHERINE LEOCADIO DE CASTRO PMHNP-BC, ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

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

III. Provider practice location address

1201 NW 16TH ST
MIAMI FL
33125-1624
US

IV. Provider business mailing address

170 CYPRESS CLUB DR APT 728
POMPANO BEACH FL
33060-4756
US

V. Phone/Fax

Practice location:
  • Phone: 305-575-7000
  • Fax:
Mailing address:
  • Phone: 305-923-2231
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number11023525
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: