Provider Demographics
NPI:1073804357
Name:SPRENGER, SHARON LEE (LMT)
Entity Type:Individual
Prefix:
First Name:SHARON
Middle Name:LEE
Last Name:SPRENGER
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 84
Mailing Address - Street 2:
Mailing Address - City:HASTINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32145-0084
Mailing Address - Country:US
Mailing Address - Phone:904-692-4880
Mailing Address - Fax:904-692-4651
Practice Address - Street 1:206 MCCLUNG AVE.
Practice Address - Street 2:1
Practice Address - City:HASTINGS
Practice Address - State:FL
Practice Address - Zip Code:32145
Practice Address - Country:US
Practice Address - Phone:904-692-4880
Practice Address - Fax:904-692-4880
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-21
Last Update Date:2011-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA27214172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLC-8488OtherBLUECROSS/BLUESHIELD