Healthcare Provider Details

I. General information

NPI: 1851833107
Provider Name (Legal Business Name): HAZEL TABAO CASTRO APRN-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/16/2016
Last Update Date: 05/31/2024
Certification Date: 05/31/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3901 S MARYLAND PKWY
LAS VEGAS NV
89119-7537
US

IV. Provider business mailing address

3901 S MARYLAND PKWY
LAS VEGAS NV
89119-7537
US

V. Phone/Fax

Practice location:
  • Phone: 702-982-7240
  • Fax: 702-952-5444
Mailing address:
  • Phone: 702-982-7240
  • Fax: 702-952-5444

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209014354
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPRN002638
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: