Provider Demographics
NPI:1831753508
Name:CASTRO, JENNIFER LYDIA (NP-C)
Entity type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:LYDIA
Last Name:CASTRO
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:LYDIA
Other - Last Name:CASTRO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:NP-C
Mailing Address - Street 1:PO BOX 740018
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-0018
Mailing Address - Country:US
Mailing Address - Phone:773-352-1517
Mailing Address - Fax:312-929-0373
Practice Address - Street 1:333 MONTANO RD NW STE A1
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87107-5200
Practice Address - Country:US
Practice Address - Phone:505-777-3003
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-27
Last Update Date:2024-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMF04190449363LF0000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
F04190449OtherAANP CERTIFICATION BOARD