Provider Demographics
NPI:1891578787
Name:CASTO, MIRANDA JEAN (APRN, FNP-C)
Entity Type:Individual
Prefix:
First Name:MIRANDA
Middle Name:JEAN
Last Name:CASTO
Suffix:
Gender:F
Credentials:APRN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6182 MICHAEL BARKEY AVE NW
Mailing Address - Street 2:
Mailing Address - City:CANAL FULTON
Mailing Address - State:OH
Mailing Address - Zip Code:44614-8229
Mailing Address - Country:US
Mailing Address - Phone:330-317-1153
Mailing Address - Fax:
Practice Address - Street 1:1900 AKRON RD
Practice Address - Street 2:
Practice Address - City:WOOSTER
Practice Address - State:OH
Practice Address - Zip Code:44691-2518
Practice Address - Country:US
Practice Address - Phone:330-264-4899
Practice Address - Fax:330-264-6879
Is Sole Proprietor?:No
Enumeration Date:2023-08-15
Last Update Date:2023-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.0034572363LP2300X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care