Healthcare Provider Details

I. General information

NPI: 1679161129
Provider Name (Legal Business Name): STEVEN PAUL SPONAUGLE FNP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/08/2021
Last Update Date: 04/21/2026
Certification Date: 04/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4367 RIVERWOOD DR UNIT 110
MURRELLS INLET SC
29576-4381
US

IV. Provider business mailing address

PO BOX 421718
GEORGETOWN SC
29442-4203
US

V. Phone/Fax

Practice location:
  • Phone: 843-652-8046
  • Fax: 843-357-9771
Mailing address:
  • Phone: 843-527-7000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number27166
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number108116
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: