Provider Demographics
NPI:1356825632
Name:COVERT, MAXIMILLIAN LUKE (APRN)
Entity Type:Individual
Prefix:MR
First Name:MAXIMILLIAN
Middle Name:LUKE
Last Name:COVERT
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6250 PARK BLVD N
Mailing Address - Street 2:
Mailing Address - City:PINELLAS PARK
Mailing Address - State:FL
Mailing Address - Zip Code:33781-3237
Mailing Address - Country:US
Mailing Address - Phone:727-541-2520
Mailing Address - Fax:
Practice Address - Street 1:1301 2ND AVE SW STE 315
Practice Address - Street 2:
Practice Address - City:LARGO
Practice Address - State:FL
Practice Address - Zip Code:33770-3120
Practice Address - Country:US
Practice Address - Phone:727-587-7120
Practice Address - Fax:727-585-6850
Is Sole Proprietor?:No
Enumeration Date:2018-09-21
Last Update Date:2022-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN9490053363LG0600X, 363LA2100X, 363LP2300X
FL9490053363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care