Provider Demographics
NPI:1083399232
Name:CASTELLI, JACLYN THERESA
Entity Type:Individual
Prefix:
First Name:JACLYN
Middle Name:THERESA
Last Name:CASTELLI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:402 OAK LYNN DR
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32809-3047
Mailing Address - Country:US
Mailing Address - Phone:813-416-8540
Mailing Address - Fax:
Practice Address - Street 1:425 S HUNT CLUB BLVD STE 1051
Practice Address - Street 2:
Practice Address - City:APOPKA
Practice Address - State:FL
Practice Address - Zip Code:32703-2428
Practice Address - Country:US
Practice Address - Phone:407-786-4080
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-15
Last Update Date:2023-07-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11027060363LF0000X
FL9443137163WM0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WM0102XNursing Service ProvidersRegistered NurseMaternal Newborn