Healthcare Provider Details

I. General information

NPI: 1972370971
Provider Name (Legal Business Name): KENDALE STURDIVENT APRN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/08/2023
Last Update Date: 06/05/2024
Certification Date: 06/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10494 NORTHCLIFFE BLVD
SPRING HILL FL
34608-3656
US

IV. Provider business mailing address

5400 PINEHURST DR
SPRING HILL FL
34606-3833
US

V. Phone/Fax

Practice location:
  • Phone: 352-686-3991
  • Fax:
Mailing address:
  • Phone: 352-277-5348
  • Fax: 352-606-2857

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN11030081
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: