Healthcare Provider Details

I. General information

NPI: 1265237796
Provider Name (Legal Business Name): TAMMY PERRY SPRUILL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/18/2025
Last Update Date: 02/18/2025
Certification Date: 02/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

77 NEALY AVE
HAMPTON VA
23665-2040
US

IV. Provider business mailing address

23462 BROOKWOOD CIR
CARROLLTON VA
23314-2671
US

V. Phone/Fax

Practice location:
  • Phone: 757-225-1733
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP2201X
TaxonomyAmbulatory Care Registered Nurse
License Number0001107276
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: