Healthcare Provider Details

I. General information

NPI: 1801575907
Provider Name (Legal Business Name): BRIANNA TAI SPRUILL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/17/2023
Last Update Date: 03/25/2025
Certification Date: 03/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 FLINT CHIP DR
CHESAPEAKE VA
23320-3296
US

IV. Provider business mailing address

601 FLINT CHIP DR
CHESAPEAKE VA
23320-3296
US

V. Phone/Fax

Practice location:
  • Phone: 757-383-2795
  • Fax: 757-216-6246
Mailing address:
  • Phone: 757-383-2795
  • Fax: 757-216-6246

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172A00000X
TaxonomyDriver
License NumberA60611330
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: