Provider Demographics
NPI:1104570910
Name:STURDIVAN, RONALD (NP)
Entity type:Individual
Prefix:
First Name:RONALD
Middle Name:
Last Name:STURDIVAN
Suffix:
Gender:
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:528 SKY VIEW CT
Mailing Address - Street 2:
Mailing Address - City:BURLESON
Mailing Address - State:TX
Mailing Address - Zip Code:76028-1380
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:817-993-2659
Practice Address - Street 1:112 SW THOMAS ST STE 104
Practice Address - Street 2:
Practice Address - City:BURLESON
Practice Address - State:TX
Practice Address - Zip Code:76028-3818
Practice Address - Country:US
Practice Address - Phone:817-580-4763
Practice Address - Fax:817-993-2659
Is Sole Proprietor?:No
Enumeration Date:2022-02-10
Last Update Date:2025-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX22739736363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX22739736OtherTEXAS BOARD OF NURSING