Provider Demographics
NPI:1497526560
Name:STURDEVANT, TASHA (FNP STUDENT)
Entity Type:Individual
Prefix:
First Name:TASHA
Middle Name:
Last Name:STURDEVANT
Suffix:
Gender:F
Credentials:FNP STUDENT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2965 S 1080 W
Mailing Address - Street 2:
Mailing Address - City:PERRY
Mailing Address - State:UT
Mailing Address - Zip Code:84302-6788
Mailing Address - Country:US
Mailing Address - Phone:801-814-7032
Mailing Address - Fax:
Practice Address - Street 1:2965 S 1080 W
Practice Address - Street 2:
Practice Address - City:PERRY
Practice Address - State:UT
Practice Address - Zip Code:84302-6788
Practice Address - Country:US
Practice Address - Phone:801-814-7032
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-09
Last Update Date:2024-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
UT7303322-3102163WE0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WE0003XNursing Service ProvidersRegistered NurseEmergency
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program