Provider Demographics
NPI:1427178722
Name:CASTILLO, PAULINE SOPHIE (FNP)
Entity Type:Individual
Prefix:MS
First Name:PAULINE
Middle Name:SOPHIE
Last Name:CASTILLO
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1401 ANITA ST.
Mailing Address - Street 2:
Mailing Address - City:PUEBLO
Mailing Address - State:CO
Mailing Address - Zip Code:81001-2122
Mailing Address - Country:US
Mailing Address - Phone:719-225-6510
Mailing Address - Fax:719-542-3514
Practice Address - Street 1:1401 ANITA ST
Practice Address - Street 2:
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81001-2122
Practice Address - Country:US
Practice Address - Phone:719-225-6510
Practice Address - Fax:719-542-3514
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-30
Last Update Date:2011-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO4815363LF0000X
CO164080163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO27872769Medicaid
CO36920061Medicaid