Provider Demographics
NPI:1164920088
Name:DE CASTRO, JENTRY ANN (DNP, FNP-C)
Entity Type:Individual
Prefix:DR
First Name:JENTRY
Middle Name:ANN
Last Name:DE CASTRO
Suffix:
Gender:F
Credentials:DNP, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3701 TRAKKER TRL
Mailing Address - Street 2:UNIT 1B #35
Mailing Address - City:BOZEMAN
Mailing Address - State:MT
Mailing Address - Zip Code:59718
Mailing Address - Country:US
Mailing Address - Phone:406-404-6711
Mailing Address - Fax:
Practice Address - Street 1:43 MILL TOWN LOOP STE C
Practice Address - Street 2:
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59718-6769
Practice Address - Country:US
Practice Address - Phone:406-404-6711
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-25
Last Update Date:2022-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT139841363LF0000X
NY342519363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily