Provider Demographics
NPI:1689806572
Name:CASTILLO, JASMIN GRISEL (PAC)
Entity Type:Individual
Prefix:
First Name:JASMIN
Middle Name:GRISEL
Last Name:CASTILLO
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1170 S SEMORAN BLVD
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32807-1458
Mailing Address - Country:US
Mailing Address - Phone:407-622-7246
Mailing Address - Fax:407-599-7246
Practice Address - Street 1:1170 S SEMORAN BLVD
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32807-1458
Practice Address - Country:US
Practice Address - Phone:407-622-7246
Practice Address - Fax:407-599-7246
Is Sole Proprietor?:No
Enumeration Date:2009-08-11
Last Update Date:2013-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9102631363A00000X
FLPA363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLGL129ZMedicare PIN