Provider Demographics
NPI:1861849085
Name:DECASTRO, MARIA (DNP)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:
Last Name:DECASTRO
Suffix:
Gender:F
Credentials:DNP
Other - Prefix:
Other - First Name:MA
Other - Middle Name:VERONICA
Other - Last Name:JOSE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:364 MINOLA DR
Mailing Address - Street 2:
Mailing Address - City:MIAMI SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33166-6034
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5802 E FOWLER AVE
Practice Address - Street 2:
Practice Address - City:TEMPLE TERRACE
Practice Address - State:FL
Practice Address - Zip Code:33617-3300
Practice Address - Country:US
Practice Address - Phone:813-442-7493
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-17
Last Update Date:2023-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX878500163W00000X
WARN60581932163W00000X
WAAP61083966363LF0000X
GAGAA-NP000063363LF0000X
FL11024650363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily