Healthcare Provider Details

I. General information

NPI: 1003741307
Provider Name (Legal Business Name): BLUESPRIG
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/17/2026
Last Update Date: 08/10/2026
Certification Date: 08/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 INTERNATIONAL PKWY STE 200
LAKE MARY FL
32746-5028
US

IV. Provider business mailing address

300 INTERNATIONAL PKWY STE 200
LAKE MARY FL
32746-5028
US

V. Phone/Fax

Practice location:
  • Phone: 661-718-5095
  • Fax:
Mailing address:
  • Phone: 661-718-5095
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name: AONEE MCDONALD
Title or Position: RBT
Credential:
Phone: 661-718-5095