Provider Demographics
NPI:1639883887
Name:CASTEEL, JENNIFER MARION (MEDICAL TATTOOIST)
Entity Type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:MARION
Last Name:CASTEEL
Suffix:
Gender:F
Credentials:MEDICAL TATTOOIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29 ARENTA ST
Mailing Address - Street 2:
Mailing Address - City:SAINT AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32084-4165
Mailing Address - Country:US
Mailing Address - Phone:904-531-6285
Mailing Address - Fax:
Practice Address - Street 1:3287 A, US-17
Practice Address - Street 2:
Practice Address - City:GREEN COVE SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32043
Practice Address - Country:US
Practice Address - Phone:904-531-6285
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-12
Last Update Date:2023-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL10-44-2432988246ZA2600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246ZA2600XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherArt, MedicalGroup - Single Specialty