Healthcare Provider Details

I. General information

NPI: 1225814080
Provider Name (Legal Business Name): ENMANUEL CASTRO FERNANDEZ APRN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/06/2023
Last Update Date: 03/18/2025
Certification Date: 03/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3140 S FALKENBURG RD STE 102
RIVERVIEW FL
33578-2594
US

IV. Provider business mailing address

8400 NW 33RD ST STE 201
DORAL FL
33122-1937
US

V. Phone/Fax

Practice location:
  • Phone: 844-665-4827
  • Fax:
Mailing address:
  • Phone: 844-665-4827
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number11023556
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: