Provider Demographics
NPI:1538572250
Name:CASTRILLON, JESSICA MARIE (RN)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:MARIE
Last Name:CASTRILLON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 HILLTOP RD
Mailing Address - Street 2:
Mailing Address - City:LEVITTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:11756-2212
Mailing Address - Country:US
Mailing Address - Phone:516-782-3044
Mailing Address - Fax:
Practice Address - Street 1:22 HILLTOP RD
Practice Address - Street 2:
Practice Address - City:LEVITTOWN
Practice Address - State:NY
Practice Address - Zip Code:11756-2212
Practice Address - Country:US
Practice Address - Phone:516-782-3044
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-10
Last Update Date:2014-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY661033163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse