Provider Demographics
NPI:1689109084
Name:TRKULJA-CASTRO, DIANE (NURSE PRACTITIONER)
Entity type:Individual
Prefix:
First Name:DIANE
Middle Name:
Last Name:TRKULJA-CASTRO
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3100 VILLAGE PT STE 250
Mailing Address - Street 2:
Mailing Address - City:CHESTERTON
Mailing Address - State:IN
Mailing Address - Zip Code:46304-9695
Mailing Address - Country:US
Mailing Address - Phone:219-440-4835
Mailing Address - Fax:855-238-6150
Practice Address - Street 1:3100 VILLAGE PT STE 250
Practice Address - Street 2:
Practice Address - City:CHESTERTON
Practice Address - State:IN
Practice Address - Zip Code:46304-9695
Practice Address - Country:US
Practice Address - Phone:219-440-4835
Practice Address - Fax:855-238-6150
Is Sole Proprietor?:No
Enumeration Date:2017-04-24
Last Update Date:2025-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28187141A163W00000X
IN71007089A363LF0000X, 363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No163W00000XNursing Service ProvidersRegistered Nurse
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily