Healthcare Provider Details

I. General information

NPI: 1821815242
Provider Name (Legal Business Name): NAIMI CASTILLO FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/25/2024
Last Update Date: 12/20/2024
Certification Date: 12/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13127 VAIL RIDGE DR
RIVERVIEW FL
33579-7196
US

IV. Provider business mailing address

4520 W ELM ST
TAMPA FL
33614-3629
US

V. Phone/Fax

Practice location:
  • Phone: 813-661-6199
  • Fax:
Mailing address:
  • Phone: 813-998-4495
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF09240542
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: