Healthcare Provider Details

I. General information

NPI: 1770418253
Provider Name (Legal Business Name): CARNELL JAMES SPRUILL NURSE PRACTITIONER
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/16/2026
Last Update Date: 06/16/2026
Certification Date: 06/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

271 NEW JERSEY AVE
BROOKLYN NY
11207-3505
US

IV. Provider business mailing address

271 NEW JERSEY AVE
BROOKLYN NY
11207-3505
US

V. Phone/Fax

Practice location:
  • Phone: 516-419-8159
  • Fax: 516-419-8159
Mailing address:
  • Phone: 516-419-8159
  • Fax: 516-419-8159

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number408769
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: