Healthcare Provider Details

I. General information

NPI: 1164920088
Provider Name (Legal Business Name): JENTRY ANN DE CASTRO DNP, FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JENTRY ANN WHEATON

II. Dates (important events)

Enumeration Date: 01/25/2018
Last Update Date: 08/12/2026
Certification Date: 08/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

228 PARK AVE S STE 16389
NEW YORK NY
10003-0103
US

IV. Provider business mailing address

169 MADISON AVE STE 38114
NEW YORK NY
10016-5101
US

V. Phone/Fax

Practice location:
  • Phone: 646-876-8455
  • Fax:
Mailing address:
  • Phone: 646-876-8455
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1-21519
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN10048628
License Number StateMA
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number907091
License Number StateMS
# 4
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN11038489
License Number StateFL
# 5
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number342519
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: