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General NPI Number Information
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NPI Number | 1992037501
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Entity Type | Organization
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Legal Business Name | MARJA J SPROCK MD, PLLC
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Dates
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Enumeration Date | 02/06/2010
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Last Update Date | 06/03/2024
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Provider Practice Location Address
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Address Line | 101 EYSTER BLVD
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City | ROCKLEDGE
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State | FL
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Zip | 32955-3608
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Country | US
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Telephone | 321-806-3929
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Fax | 321-809-3923
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Provider Business Mailing Address
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Address Line | 101 EYSTER BLVD
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City | ROCKLEDGE
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State | FL
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Zip | 32955-3608
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Country | US
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Telephone | 321-806-3929
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Fax | 321-806-3928
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | TRISTAN KATTENBERG
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Credential |
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Telephone | 321-338-2726
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207VF0040X
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Taxonomy Name | Urogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number | G10000003345
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License Number State | FL
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