Provider Demographics
NPI:1992201875
Name:CASTNER, NICHOLAS BRADFORD (MD)
Entity Type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:BRADFORD
Last Name:CASTNER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4919 MEMORIAL HWY STE 150
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33634-7516
Mailing Address - Country:US
Mailing Address - Phone:813-333-1512
Mailing Address - Fax:813-333-1561
Practice Address - Street 1:4197 WOODLANDS PKWY
Practice Address - Street 2:
Practice Address - City:PALM HARBOR
Practice Address - State:FL
Practice Address - Zip Code:34685-3493
Practice Address - Country:US
Practice Address - Phone:727-786-3810
Practice Address - Fax:727-786-3855
Is Sole Proprietor?:No
Enumeration Date:2018-04-01
Last Update Date:2023-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME162846207ND0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic Surgery