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General NPI Number Information
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NPI Number | 1306312624
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Entity Type | Individual
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Provider Name | SAMUEL SPRINKLE
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Gender | Male
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Dates
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Enumeration Date | 10/15/2018
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Last Update Date | 03/20/2023
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Provider Practice Location Address
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Address Line | 12724 GRAN BAY PKWY W STE 410
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City | JACKSONVILLE
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State | FL
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Zip | 32258-9486
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Country | US
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Telephone | 740-935-9240
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Fax | 740-529-0385
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Provider Business Mailing Address
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Address Line | 2325 MYRA ST APT 2
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City | JACKSONVILLE
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State | FL
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Zip | 32204-3630
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Country | US
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Telephone | 740-935-9240
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Fax | 740-529-0385
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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 | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number | 1-22-60251
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License Number State | FL
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