Provider Demographics
NPI:1073581294
Name:CASTAGNO, JACQUELINE CHRISTINE (MD)
Entity Type:Individual
Prefix:DR
First Name:JACQUELINE
Middle Name:CHRISTINE
Last Name:CASTAGNO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2120 E JOHNSON AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32514-6091
Mailing Address - Country:US
Mailing Address - Phone:850-494-4600
Mailing Address - Fax:
Practice Address - Street 1:2120 E JOHNSON AVE STE 101
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32514-6091
Practice Address - Country:US
Practice Address - Phone:850-494-4600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-14
Last Update Date:2021-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA044759207VX0201X
FLME107731207VX0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VX0201XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologic Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00772285AMedicaid
FL002533800Medicaid
GA16BDGFJMedicare ID - Type Unspecified
FL002533800Medicaid
DL860ZMedicare PIN