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NPI Code Detail

MEDICARE: ANGIE LIZETH CASTRO HERNANDEZ RN

MEDICARE: ANGIE LIZETH CASTRO HERNANDEZ RN
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
1163W00000XRegistered NurseRN9499958FL

General Provider Information

NPI Number : 1710457155
Entity Type Code : Individual
Provider Name (Legal Business Name) : ANGIE LIZETH CASTRO HERNANDEZ RN
Provider Business Mailing Address
First Line : 719 E OAK ST
Second Line :
City : KISSIMMEE
State : FL
Zip : 34744-4580
Country : US
Telephone Number : 407-846-0533
Fax Number :
Provider Business Practice Location Address
First Line : 711 E OAK ST
Second Line :
City : KISSIMMEE
State : FL
Zip : 34744-4573
Country : US
Telephone Number : 407-845-0533
Fax Number : 407-518-1730
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/28/2018
Last Update Date : 06/12/2019

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