Healthcare Provider Details

I. General information

NPI: 1689109084
Provider Name (Legal Business Name): DIANE TRKULJA-CASTRO NURSE PRACTITIONER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/24/2017
Last Update Date: 01/07/2025
Certification Date: 01/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3100 VILLAGE PT STE 250
CHESTERTON IN
46304-9695
US

IV. Provider business mailing address

3100 VILLAGE PT STE 250
CHESTERTON IN
46304-9695
US

V. Phone/Fax

Practice location:
  • Phone: 219-440-4835
  • Fax: 855-238-6150
Mailing address:
  • Phone: 219-440-4835
  • Fax: 855-238-6150

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number28187141A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number71007089A
License Number StateIN
# 3
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number71007089A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: