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General NPI Number Information
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NPI Number | 1003175126
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Entity Type | Individual
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Provider Name | JOHANA BEATRIZ CASTRO WAGNER M.D
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Gender | Female
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Dates
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Enumeration Date | 05/09/2012
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Last Update Date | 12/07/2025
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Provider Practice Location Address
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Address Line | 11200 SEMINOLE BLVD STE 310
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City | LARGO
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State | FL
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Zip | 33778-3239
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Country | US
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Telephone | 727-397-8557
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Fax | 727-397-4459
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Provider Business Mailing Address
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Address Line | PO BOX 917770
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City | ORLANDO
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State | FL
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Zip | 32891-0001
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Country | US
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Telephone | 813-821-8038
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2080P0201X
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Taxonomy Name | Pediatric Allergy/Immunology Physician
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License Number | ME124372
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License Number State | FL
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