Provider Demographics
NPI:1558903104
Name:CASTRO, EDUARDO (APRN)
Entity Type:Individual
Prefix:
First Name:EDUARDO
Middle Name:
Last Name:CASTRO
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10491 SW SARAH WAY
Mailing Address - Street 2:
Mailing Address - City:PORT SAINT LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34987-1979
Mailing Address - Country:US
Mailing Address - Phone:772-812-9264
Mailing Address - Fax:
Practice Address - Street 1:10491 SW SARAH WAY
Practice Address - Street 2:
Practice Address - City:PORT SAINT LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34987-1979
Practice Address - Country:US
Practice Address - Phone:772-812-9264
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-15
Last Update Date:2019-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11004587363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily