Provider Demographics
NPI:1265659635
Name:SPRENTALL-NANKERVIS, ELLEN F (BS, PHARMD)
Entity Type:Individual
Prefix:DR
First Name:ELLEN
Middle Name:F
Last Name:SPRENTALL-NANKERVIS
Suffix:
Gender:F
Credentials:BS, PHARMD
Other - Prefix:DR
Other - First Name:ELLEN
Other - Middle Name:F
Other - Last Name:NANKERVIS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:BS, PHARMD
Mailing Address - Street 1:PO BOX 864
Mailing Address - Street 2:
Mailing Address - City:LADY LAKE
Mailing Address - State:FL
Mailing Address - Zip Code:32158-0864
Mailing Address - Country:US
Mailing Address - Phone:352-259-2844
Mailing Address - Fax:352-259-3317
Practice Address - Street 1:702 SW 8TH ST
Practice Address - Street 2:
Practice Address - City:BENTONVILLE
Practice Address - State:AR
Practice Address - Zip Code:72716-6209
Practice Address - Country:US
Practice Address - Phone:352-259-2844
Practice Address - Fax:352-259-3317
Is Sole Proprietor?:No
Enumeration Date:2007-04-19
Last Update Date:2011-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS 383541835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy