Healthcare Provider Details

I. General information

NPI: 1215494455
Provider Name (Legal Business Name): JAZMIN CASTILLO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/25/2019
Last Update Date: 02/25/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3660 MAGUIRE BLVD STE 100
ORLANDO FL
32803-3059
US

IV. Provider business mailing address

13704 LAGOON ISLE WAY APT 102
ORLANDO FL
32824-5119
US

V. Phone/Fax

Practice location:
  • Phone: 407-674-6870
  • Fax: 407-674-6873
Mailing address:
  • Phone: 407-227-2963
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN9445057
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: