Healthcare Provider Details

I. General information

NPI: 1003009176
Provider Name (Legal Business Name): CHERYL A. SPRAGG PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/22/2007
Last Update Date: 08/23/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2100 SE OCEAN BLVD SUITE 100
STUART FL
34996-3332
US

IV. Provider business mailing address

1150 SW GOODMAN AVE
PORT ST LUCIE FL
34953-1433
US

V. Phone/Fax

Practice location:
  • Phone: 772-223-2115
  • Fax: 772-337-9034
Mailing address:
  • Phone: 937-360-8152
  • Fax: 772-337-9034

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number50.002263
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA9105543
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: