Provider Demographics
NPI:1508194895
Name:PRINGLE, JOHN SAMUEL
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:SAMUEL
Last Name:PRINGLE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:252 W ARDICE AVE
Mailing Address - Street 2:421
Mailing Address - City:EUSTIS
Mailing Address - State:FL
Mailing Address - Zip Code:32726-6239
Mailing Address - Country:US
Mailing Address - Phone:352-317-7818
Mailing Address - Fax:
Practice Address - Street 1:10507 NW 146TH PL
Practice Address - Street 2:
Practice Address - City:ALACHUA
Practice Address - State:FL
Practice Address - Zip Code:32615-5723
Practice Address - Country:US
Practice Address - Phone:352-317-7818
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-24
Last Update Date:2011-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL0-05-1666103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst