Provider Demographics
NPI:1275882458
Name:CASTRELLON, DEMETRIA ANN (ACNP)
Entity Type:Individual
Prefix:
First Name:DEMETRIA
Middle Name:ANN
Last Name:CASTRELLON
Suffix:
Gender:F
Credentials:ACNP
Other - Prefix:
Other - First Name:DEMETRIA
Other - Middle Name:ANN
Other - Last Name:ALVIDREZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1700 CURIE DRIVE
Mailing Address - Street 2:4800
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79902
Mailing Address - Country:US
Mailing Address - Phone:915-351-7000
Mailing Address - Fax:915-351-7004
Practice Address - Street 1:1700 CURIE DRIVE
Practice Address - Street 2:4800
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79902
Practice Address - Country:US
Practice Address - Phone:915-351-7000
Practice Address - Fax:915-351-7004
Is Sole Proprietor?:No
Enumeration Date:2012-09-05
Last Update Date:2015-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX711208363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXAP121776OtherADVANCED PRACTICE LICENSE NUMBER
TX711208OtherTX NURSING LICENSE