Provider Demographics
NPI:1649653254
Name:CASTILLA, MICHELLE VICTORIA (CNP)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:VICTORIA
Last Name:CASTILLA
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:MICHELLE
Other - Middle Name:VICTORIA
Other - Last Name:VELAZQUEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CNP
Mailing Address - Street 1:701 TECH CENTER DR STE 250
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43230-1987
Mailing Address - Country:US
Mailing Address - Phone:614-878-0600
Mailing Address - Fax:614-396-2480
Practice Address - Street 1:5775 N MEADOWS DR STE C
Practice Address - Street 2:
Practice Address - City:GROVE CITY
Practice Address - State:OH
Practice Address - Zip Code:43123-7300
Practice Address - Country:US
Practice Address - Phone:614-396-2684
Practice Address - Fax:614-396-2480
Is Sole Proprietor?:No
Enumeration Date:2015-06-30
Last Update Date:2023-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH17302363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily