Provider Demographics
NPI:1205512720
Name:CASTANEDA, JUANA ELENA I (PROPIETARIO)
Entity type:Individual
Prefix:MISS
First Name:JUANA
Middle Name:ELENA
Last Name:CASTANEDA
Suffix:I
Gender:F
Credentials:PROPIETARIO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1008 ROBERT AVE
Mailing Address - Street 2:
Mailing Address - City:LEHIGH ACRES
Mailing Address - State:FL
Mailing Address - Zip Code:33936-0913
Mailing Address - Country:US
Mailing Address - Phone:239-476-2169
Mailing Address - Fax:
Practice Address - Street 1:1008 ROBERT AVE
Practice Address - Street 2:
Practice Address - City:LEHIGH ACRES
Practice Address - State:FL
Practice Address - Zip Code:33936-0913
Practice Address - Country:US
Practice Address - Phone:239-476-2169
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-27
Last Update Date:2024-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9563262163WP0808X, 163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health