=====================================================
General NPI Number Information
=====================================================
NPI Number | 1508581018
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ANGEL A CASTRO DNP,APRN,FNP
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/06/2022
-----------------------------------------------------
Last Update Date | 11/04/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1555 N KROME AVE
-----------------------------------------------------
City | HOMESTEAD
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33030-3232
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-266-0222
-----------------------------------------------------
Fax | 305-266-0848
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4161 W 2ND AVE
-----------------------------------------------------
City | HIALEAH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33012-4421
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 786-223-4600
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363L00000X
-----------------------------------------------------
Taxonomy Name | Nurse Practitioner
-----------------------------------------------------
License Number | 11014778
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | 11014778
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------