Provider Demographics
NPI:1689490997
Name:LOCASTO, TERESA GRACE (PA)
Entity type:Individual
Prefix:
First Name:TERESA
Middle Name:GRACE
Last Name:LOCASTO
Suffix:
Gender:
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:252 WOODCREST DR
Mailing Address - Street 2:
Mailing Address - City:LOVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:45140-7773
Mailing Address - Country:US
Mailing Address - Phone:513-833-6221
Mailing Address - Fax:
Practice Address - Street 1:252 WOODCREST DR
Practice Address - Street 2:
Practice Address - City:LOVELAND
Practice Address - State:OH
Practice Address - Zip Code:45140-7773
Practice Address - Country:US
Practice Address - Phone:513-833-6221
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-02
Last Update Date:2025-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH50.009255RX363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant