MEDICARE: MRS. JENNA MARIE CASTRO DNP

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	363L00000X	Nurse Practitioner	622155	NY

General Provider Information

NPI Number	:	1821728411
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JENNA MARIE CASTRO DNP

Provider Business Mailing Address
First Line	:	43 WESTCHESTER AVENUE
Second Line	:	2ND FLOOR STE 1
City	:	BRONX
State	:	NY
Zip	:	10461
Country	:	US
Telephone Number	:	646-762-2573
Fax Number	:	646-762-2574

Provider Business Practice Location Address
First Line	:	1918 HEIGHT AVENUE
Second Line	:	2A
City	:	BRONX
State	:	NY
Zip	:	10461
Country	:	US
Telephone Number	:	347-657-3149
Fax Number	:	646-762-2574

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

Provider Enumeration Date	:	06/15/2022
Last Update Date	:	06/15/2022

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