Provider Demographics
NPI:1346947678
Name:STURDIVANT, MARIA PAIGE
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:PAIGE
Last Name:STURDIVANT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1520 FLOURNOY CIR E APT 5314
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33764-1424
Mailing Address - Country:US
Mailing Address - Phone:814-823-2249
Mailing Address - Fax:
Practice Address - Street 1:1001 S FORT HARRISON AVE STE 101
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33756-3941
Practice Address - Country:US
Practice Address - Phone:727-441-5044
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-07
Last Update Date:2023-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9116749363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical