MEDICARE: MS. SARA IVETTE CASTANEDA 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
1	163W00000X	Registered Nurse	RN 9370372	FL

General Provider Information

NPI Number	:	1760862940
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. SARA IVETTE CASTANEDA RN

Provider Business Mailing Address
First Line	:	2406 PALM CREEK AVE
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32822-8411
Country	:	US
Telephone Number	:	787-512-0062
Fax Number	:

Provider Business Practice Location Address
First Line	:	2406 PALM CREEK AVE
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32822-8411
Country	:	US
Telephone Number	:	787-512-0062
Fax Number	:

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

Provider Enumeration Date	:	06/03/2015
Last Update Date	:	06/03/2015

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