Provider Demographics
NPI:1477099596
Name:PALM BEACH NEUROSURGERY
Entity Type:Organization
Organization Name:PALM BEACH NEUROSURGERY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN ASSISTANT
Authorized Official - Prefix:MS
Authorized Official - First Name:ILANA
Authorized Official - Middle Name:
Authorized Official - Last Name:SPRAGUE
Authorized Official - Suffix:
Authorized Official - Credentials:PA-C
Authorized Official - Phone:248-505-9648
Mailing Address - Street 1:1111 E SUNRISE BLVD
Mailing Address - Street 2:APT #603
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33304-2847
Mailing Address - Country:US
Mailing Address - Phone:248-505-9648
Mailing Address - Fax:
Practice Address - Street 1:3319 STATE ROAD 7
Practice Address - Street 2:SUITE 313
Practice Address - City:WELLINGTON
Practice Address - State:FL
Practice Address - Zip Code:33449-8094
Practice Address - Country:US
Practice Address - Phone:561-433-4444
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-12
Last Update Date:2017-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9110078363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgicalGroup - Single Specialty