Provider Demographics
NPI:1124617733
Name:STURM-EASTON, DUSTIN M (NP)
Entity type:Individual
Prefix:
First Name:DUSTIN
Middle Name:M
Last Name:STURM-EASTON
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1055 3RD ST
Mailing Address - Street 2:
Mailing Address - City:DAYTONA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32117-4101
Mailing Address - Country:US
Mailing Address - Phone:386-252-3686
Mailing Address - Fax:
Practice Address - Street 1:1055 3RD ST
Practice Address - Street 2:
Practice Address - City:DAYTONA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32117-4101
Practice Address - Country:US
Practice Address - Phone:386-252-3686
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-18
Last Update Date:2023-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV92471163W00000X
OH410024163W00000X
OH0028204363LF0000X
WV108120363LF0000X
FLAPRN11020484363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse