Provider Demographics
NPI:1114928157
Name:STANTON, MAURICIA DORA (ARNP-BC)
Entity Type:Individual
Prefix:MS
First Name:MAURICIA
Middle Name:DORA
Last Name:STANTON
Suffix:
Gender:F
Credentials:ARNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1005 COLLEGE BLVD WEST
Mailing Address - Street 2:SUITE B
Mailing Address - City:NICEVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32578-1060
Mailing Address - Country:US
Mailing Address - Phone:850-279-6815
Mailing Address - Fax:
Practice Address - Street 1:1005 COLLEGE BLVD WEST
Practice Address - Street 2:SUITE B
Practice Address - City:NICEVILLE
Practice Address - State:FL
Practice Address - Zip Code:32578-1060
Practice Address - Country:US
Practice Address - Phone:850-279-6815
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-08-01
Last Update Date:2022-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL3114742363LF0000X, 363LP2300X, 363LW0102X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health