Basic Information
| Provider Information | |||||||||
| NPI: | 1851635650 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CASTILLO | ||||||||
| FirstName: | LUNETTE | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 10549 | ||||||||
| Address2: | |||||||||
| City: | ST PETERSBURG | ||||||||
| State: | FL | ||||||||
| PostalCode: | 337330549 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7278248181 | ||||||||
| FaxNumber: | 7278248166 | ||||||||
| Practice Location | |||||||||
| Address1: | 7550 43RD ST N | ||||||||
| Address2: | |||||||||
| City: | PINELLAS PARK | ||||||||
| State: | FL | ||||||||
| PostalCode: | 337813601 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7278248181 | ||||||||
| FaxNumber: | 7275417984 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/16/2012 | ||||||||
| LastUpdateDate: | 05/10/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 209.009998 | IL | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
ID Information
| ID | Type | State | Issuer | Description | 018255600 | 05 | FL | MEDICAID |