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General NPI Number Information
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NPI Number | 1093790875
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Entity Type | Individual
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Provider Name | MARILYN T SPRENKLE M.D.
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Gender | Female
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Dates
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Enumeration Date | 12/14/2005
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Last Update Date | 01/03/2019
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Provider Practice Location Address
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Address Line | 36468 EMERALD COAST PARKWAY UNIT 2101
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City | DESTIN
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State | FL
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Zip | 32541
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Country | US
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Telephone | 850-659-6556
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Fax | 850-249-1308
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Provider Business Mailing Address
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Address Line | 1005 MAR WALT DR
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City | FORT WALTON BEACH
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State | FL
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Zip | 32547-6707
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Country | US
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Telephone | 850-863-8100
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Fax | 850-863-2303
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | ME87333
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License Number State | FL
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