Healthcare Provider Details

I. General information

NPI: 1043743289
Provider Name (Legal Business Name): BRIANNA CASTILLO M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/05/2017
Last Update Date: 08/02/2023
Certification Date: 08/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11601 SHELDON RD
TAMPA FL
33626-4306
US

IV. Provider business mailing address

4919 MEMORIAL HWY STE 150
TAMPA FL
33634-7516
US

V. Phone/Fax

Practice location:
  • Phone: 813-324-6630
  • Fax: 813-926-1500
Mailing address:
  • Phone: 813-333-1512
  • Fax: 813-333-1561

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ND0101X
TaxonomyMOHS-Micrographic Surgery Physician
License NumberME162672
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: