Healthcare Provider Details

I. General information

NPI: 1639613623
Provider Name (Legal Business Name): LARISA SHTURMAK MSN, APN, NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/09/2016
Last Update Date: 12/09/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

77 N AIRLITE ST
ELGIN IL
60123-4912
US

IV. Provider business mailing address

5220 BELFORT RD
JACKSONVILLE FL
32256-6017
US

V. Phone/Fax

Practice location:
  • Phone: 847-695-3200
  • Fax:
Mailing address:
  • Phone: 904-446-3400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number209.015260
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number209.015260
License Number StateIL
# 3
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number209.015260
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: