Provider Demographics
NPI:1174720619
Name:VILLACASTIN, ALEXANDER TAN (ARNP)
Entity type:Individual
Prefix:MR
First Name:ALEXANDER
Middle Name:TAN
Last Name:VILLACASTIN
Suffix:
Gender:M
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10489 N FLORIDA AVE
Mailing Address - Street 2:
Mailing Address - City:CITRUS SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:34434-3268
Mailing Address - Country:US
Mailing Address - Phone:352-382-8282
Mailing Address - Fax:
Practice Address - Street 1:10489 N FLORIDA AVE
Practice Address - Street 2:
Practice Address - City:CITRUS SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:34434-3268
Practice Address - Country:US
Practice Address - Phone:352-489-2486
Practice Address - Fax:352-489-5786
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-28
Last Update Date:2016-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP2986862363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health