Provider Demographics
NPI:1134141252
Name:NESBITT, STUART J (PA)
Entity Type:Individual
Prefix:
First Name:STUART
Middle Name:J
Last Name:NESBITT
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5601 N DIXIE HWY
Mailing Address - Street 2:SUITE 209
Mailing Address - City:OAKLAND PARK
Mailing Address - State:FL
Mailing Address - Zip Code:33334-4148
Mailing Address - Country:US
Mailing Address - Phone:954-942-7083
Mailing Address - Fax:954-491-2628
Practice Address - Street 1:5601 N DIXIE HWY
Practice Address - Street 2:SUITE 209
Practice Address - City:OAKLAND PARK
Practice Address - State:FL
Practice Address - Zip Code:33334-4148
Practice Address - Country:US
Practice Address - Phone:954-942-7083
Practice Address - Fax:954-491-2628
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA0001776363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical