Healthcare Provider Details

I. General information

NPI: 1497619407
Provider Name (Legal Business Name): JENNIFER CASTILLO, NURSE PRACTITIONER IN ADULT HEALTH, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/13/2025
Last Update Date: 12/13/2025
Certification Date: 12/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1386 WHITTIER AVE
MERRICK NY
11566-1739
US

IV. Provider business mailing address

1386 WHITTIER AVE
MERRICK NY
11566-1739
US

V. Phone/Fax

Practice location:
  • Phone: 646-401-1852
  • Fax:
Mailing address:
  • Phone: 646-401-1852
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MRS. JENNIFER CASTILLO
Title or Position: NURSE PRACTITIONER/ OWNER
Credential: NP, MSN, AGP
Phone: 646-401-1852