Healthcare Provider Details

I. General information

NPI: 1700096773
Provider Name (Legal Business Name): KAREN A SPROUL FNP - C, ANP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/22/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

STONYBROOK UNIVERSITY HOSPITAL DEPT. OF EMERGENCY MEDICINE - HSC LEVEL 4 - ROOM 080
STONY BROOK NY
11794-8350
US

IV. Provider business mailing address

111 PENINSULA DR
PORT JEFFERSON NY
11777-1110
US

V. Phone/Fax

Practice location:
  • Phone: 631-444-2478
  • Fax: 631-444-3919
Mailing address:
  • Phone: 631-642-1733
  • Fax: 631-642-1733

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF335149-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: