Healthcare Provider Details

I. General information

NPI: 1235058587
Provider Name (Legal Business Name): SANDRA ISABEL CASTILLO ALLEN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2026
Last Update Date: 08/12/2026
Certification Date: 08/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

139 GOLDEN EAGLE CT
SANTA ROSA BEACH FL
32459-8314
US

IV. Provider business mailing address

139 GOLDEN EAGLE CT
SANTA ROSA BEACH FL
32459-8314
US

V. Phone/Fax

Practice location:
  • Phone: 786-818-0133
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number11049431
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: