Healthcare Provider Details

I. General information

NPI: 1609461490
Provider Name (Legal Business Name): FRANCES SPRADLEY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/04/2021
Last Update Date: 03/04/2021
Certification Date: 02/25/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10625 BIG BEND RD
RIVERVIEW FL
33579-7176
US

IV. Provider business mailing address

10625 BIG BEND RD
RIVERVIEW FL
33579-7176
US

V. Phone/Fax

Practice location:
  • Phone: 813-549-0931
  • Fax:
Mailing address:
  • Phone: 813-549-0931
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License NumberDH25264
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: