Healthcare Provider Details

I. General information

NPI: 1629951447
Provider Name (Legal Business Name): NIKITA STURGILL
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/29/2025
Last Update Date: 04/13/2026
Certification Date: 04/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4970 HIGHWAY 97
MC DAVID FL
32568-2015
US

IV. Provider business mailing address

4970 HIGHWAY 97
MC DAVID FL
32568-2015
US

V. Phone/Fax

Practice location:
  • Phone: --
  • Fax:
Mailing address:
  • Phone: --
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberAPRN11041232
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363LC0200X
TaxonomyCritical Care Medicine Nurse Practitioner
License Number11041232
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: