Healthcare Provider Details

I. General information

NPI: 1285014910
Provider Name (Legal Business Name): SAIGE MARY LAXSON PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SAIGE MARY GURTOWSKI PA-C

II. Dates (important events)

Enumeration Date: 06/08/2015
Last Update Date: 11/05/2025
Certification Date: 11/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2220 SE OCEAN BLVD STE 301
STUART FL
34996-3301
US

IV. Provider business mailing address

2220 SE OCEAN BLVD STE 301
STUART FL
34996-3301
US

V. Phone/Fax

Practice location:
  • Phone: 772-220-3339
  • Fax: 772-286-2635
Mailing address:
  • Phone: 772-220-3339
  • Fax: 772-286-2635

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA10928
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA9114227
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: