Healthcare Provider Details

I. General information

NPI: 1699109629
Provider Name (Legal Business Name): JASON CASTRO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/27/2013
Last Update Date: 08/27/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2341 MCCALLIE AVE SUITE 402
CHATTANOOGA TN
37404-3239
US

IV. Provider business mailing address

2341 MCCALLIE AVE SUITE 402
CHATTANOOGA TN
37404-3239
US

V. Phone/Fax

Practice location:
  • Phone: 423-698-3309
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number160815
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: