Provider Demographics
NPI:1609972264
Name:CASTANEDA, ILEANA (ARNP)
Entity Type:Individual
Prefix:MRS
First Name:ILEANA
Middle Name:
Last Name:CASTANEDA
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 SW 113TH AVE #103
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33174
Mailing Address - Country:US
Mailing Address - Phone:786-718-5290
Mailing Address - Fax:786-441-4753
Practice Address - Street 1:9250 W FLAGLER ST STE 600
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33174-3460
Practice Address - Country:US
Practice Address - Phone:305-408-5700
Practice Address - Fax:786-441-4753
Is Sole Proprietor?:No
Enumeration Date:2006-09-14
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP 2113852363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLE1419ZMedicare ID - Type UnspecifiedMEDICARE PROVIDER ARNP