Provider Demographics
NPI:1710533880
Name:SPRALLING, TONYA
Entity Type:Individual
Prefix:
First Name:TONYA
Middle Name:
Last Name:SPRALLING
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 1:703 HANCOCK AVE
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:VA
Mailing Address - Zip Code:23701-3344
Mailing Address - Country:US
Mailing Address - Phone:757-215-8797
Mailing Address - Fax:
Practice Address - Street 1:703 HANCOCK AVE
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:VA
Practice Address - Zip Code:23701-3344
Practice Address - Country:US
Practice Address - Phone:757-215-8797
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-14
Last Update Date:2019-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAT60649397172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver