Provider Demographics
NPI:1639797426
Name:CASTILLO, ALEXANDRA RACHEL
Entity Type:Individual
Prefix:
First Name:ALEXANDRA
Middle Name:RACHEL
Last Name:CASTILLO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:455 SW 200TH TER
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33029-1247
Mailing Address - Country:US
Mailing Address - Phone:954-665-3374
Mailing Address - Fax:
Practice Address - Street 1:3700 WASHINGTON ST STE A
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33021-8256
Practice Address - Country:US
Practice Address - Phone:954-989-4700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-08
Last Update Date:2022-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11009457363LP2300X
FLRN9435328163WM0705X
FLARPN11009457363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No163WM0705XNursing Service ProvidersRegistered NurseMedical-Surgical