Provider Demographics
NPI:1023756921
Name:STURGIS, MADISON HANNA (PA-C)
Entity type:Individual
Prefix:
First Name:MADISON
Middle Name:HANNA
Last Name:STURGIS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2255 GLADES RD STE 228W
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33431-7391
Mailing Address - Country:US
Mailing Address - Phone:561-425-9483
Mailing Address - Fax:561-658-6142
Practice Address - Street 1:7116 SENNET PL
Practice Address - Street 2:
Practice Address - City:LIBERTY TOWNSHIP
Practice Address - State:OH
Practice Address - Zip Code:45069-3209
Practice Address - Country:US
Practice Address - Phone:513-779-5610
Practice Address - Fax:513-779-5612
Is Sole Proprietor?:No
Enumeration Date:2022-05-22
Last Update Date:2025-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA50.008922RX363A00000X
363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
15819941OtherCAQH