Provider Demographics
NPI:1093790875
Name:SPRENKLE, MARILYN T (MD)
Entity Type:Individual
Prefix:DR
First Name:MARILYN
Middle Name:T
Last Name:SPRENKLE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1005 MAR WALT DR
Mailing Address - Street 2:
Mailing Address - City:FORT WALTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32547-6707
Mailing Address - Country:US
Mailing Address - Phone:850-863-8100
Mailing Address - Fax:850-863-2303
Practice Address - Street 1:36468 EMERALD COAST PARKWAY
Practice Address - Street 2:UNIT 2101
Practice Address - City:DESTIN
Practice Address - State:FL
Practice Address - Zip Code:32541
Practice Address - Country:US
Practice Address - Phone:850-659-6556
Practice Address - Fax:850-249-1308
Is Sole Proprietor?:No
Enumeration Date:2005-12-14
Last Update Date:2019-01-03
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLME87333208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL266800900Medicaid
H66951Medicare UPIN