MEDICARE: DR. JOHANA BEATRIZ CASTRO WAGNER M.D

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2080P0201X	Pediatric Allergy/Immunology Physician	ME124372	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	DQI18	OTHER	FL	BCBS
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1003175126
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOHANA BEATRIZ CASTRO WAGNER M.D

Provider Business Mailing Address
First Line	:	PO BOX 917770
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32891-0001
Country	:	US
Telephone Number	:	813-821-8038
Fax Number	:

Provider Business Practice Location Address
First Line	:	11200 SEMINOLE BLVD STE 310
Second Line	:
City	:	LARGO
State	:	FL
Zip	:	33778-3239
Country	:	US
Telephone Number	:	727-397-8557
Fax Number	:	727-397-4459

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/09/2012
Last Update Date	:	12/07/2025

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