Provider Demographics
NPI:1184241226
Name:CASTILLO, JILLIAN ROSE (NP)
Entity type:Individual
Prefix:MRS
First Name:JILLIAN
Middle Name:ROSE
Last Name:CASTILLO
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 7362
Mailing Address - Street 2:
Mailing Address - City:SOUTH LAKE TAHOE
Mailing Address - State:CA
Mailing Address - Zip Code:96158-0362
Mailing Address - Country:US
Mailing Address - Phone:530-318-8653
Mailing Address - Fax:
Practice Address - Street 1:1005 TERMINAL WAY STE 184
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89502-2179
Practice Address - Country:US
Practice Address - Phone:214-868-4371
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-05
Last Update Date:2020-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV831935363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology