Provider Demographics
NPI:1003009176
Name:SPRAGG, CHERYL A (PA-C)
Entity Type:Individual
Prefix:MS
First Name:CHERYL
Middle Name:A
Last Name:SPRAGG
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1150 SW GOODMAN AVE
Mailing Address - Street 2:
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34953-1433
Mailing Address - Country:US
Mailing Address - Phone:937-360-8152
Mailing Address - Fax:772-337-9034
Practice Address - Street 1:2100 SE OCEAN BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:STUART
Practice Address - State:FL
Practice Address - Zip Code:34996-3332
Practice Address - Country:US
Practice Address - Phone:772-223-2115
Practice Address - Fax:772-337-9034
Is Sole Proprietor?:No
Enumeration Date:2007-08-22
Last Update Date:2011-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH50.002263363A00000X
FLPA9105543363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLY04YJOtherBCBS OF FLORIDA
FLDM382ZMedicare PIN
OHSPPA26471Medicare PIN