Provider Demographics
NPI:1619216892
Name:CASTLIN, RENA LORAINE (NP)
Entity Type:Individual
Prefix:MRS
First Name:RENA
Middle Name:LORAINE
Last Name:CASTLIN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 TOWER RD NE
Mailing Address - Street 2:SUITE 350
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30060-9411
Mailing Address - Country:US
Mailing Address - Phone:770-590-1078
Mailing Address - Fax:770-422-7306
Practice Address - Street 1:400 TOWER RD NE
Practice Address - Street 2:SUITE 350
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30060-9411
Practice Address - Country:US
Practice Address - Phone:770-590-1078
Practice Address - Fax:770-422-7306
Is Sole Proprietor?:No
Enumeration Date:2013-02-07
Last Update Date:2018-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5010852363LP0808X
GARN153122363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health