Provider Demographics
NPI:1568074821
Name:SPRADLIN, MISTY GAYLE
Entity Type:Individual
Prefix:
First Name:MISTY
Middle Name:GAYLE
Last Name:SPRADLIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2517 50TH AVE N LOT W5
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33714-2575
Mailing Address - Country:US
Mailing Address - Phone:417-298-5962
Mailing Address - Fax:
Practice Address - Street 1:4720 LOCUST ST NE APT 216
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33703-6459
Practice Address - Country:US
Practice Address - Phone:417-298-5962
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-18
Last Update Date:2020-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCNA364666376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide