Provider Demographics
NPI:1801056304
Name:STURDIVANT, ERIC (MD, APRN, FNP-C)
Entity type:Individual
Prefix:MR
First Name:ERIC
Middle Name:
Last Name:STURDIVANT
Suffix:
Gender:M
Credentials:MD, APRN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3824 CEDAR SPRINGS RD UNIT 274
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75219-4136
Mailing Address - Country:US
Mailing Address - Phone:888-749-6325
Mailing Address - Fax:702-441-1969
Practice Address - Street 1:501 S. RANCHO DRIVE
Practice Address - Street 2:SUITE I-61
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89106
Practice Address - Country:US
Practice Address - Phone:888-749-6325
Practice Address - Fax:702-441-1969
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-10
Last Update Date:2021-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1026677363LF0000X
NV837695363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily