MEDICARE: BRITTA ANNE CASTALINE LPN

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	164W00000X	Licensed Practical Nurse	PN5229359	FL

General Provider Information

NPI Number	:	1740775972
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRITTA ANNE CASTALINE LPN

Provider Business Mailing Address
First Line	:	3350 VAN NUYS LOOP
Second Line	:
City	:	NEW PORT RICHEY
State	:	FL
Zip	:	34655-3117
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	200 16TH AVE SE
Second Line	:
City	:	LARGO
State	:	FL
Zip	:	33771-4400
Country	:	US
Telephone Number	:	727-585-9377
Fax Number	:

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

Provider Enumeration Date	:	06/29/2018
Last Update Date	:	06/29/2018

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