Healthcare Provider Details

I. General information

NPI: 1356911747
Provider Name (Legal Business Name): ERNESTO ZAMBRANO CASTILLO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/28/2021
Last Update Date: 05/29/2026
Certification Date: 05/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1650 SAND LAKE RD STE 112A
ORLANDO FL
32809-7671
US

IV. Provider business mailing address

9702 UNIVERSAL BLVD APT 268
ORLANDO FL
32819-8740
US

V. Phone/Fax

Practice location:
  • Phone: 786-424-1860
  • Fax:
Mailing address:
  • Phone: 786-424-1860
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number11012529
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: