Provider Demographics
NPI:1801575907
Name:SPRUILL, BRIANNA TAI
Entity type:Individual
Prefix:
First Name:BRIANNA
Middle Name:TAI
Last Name:SPRUILL
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 FLINT CHIP DR
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23320-3296
Mailing Address - Country:US
Mailing Address - Phone:757-383-2795
Mailing Address - Fax:757-216-6246
Practice Address - Street 1:601 FLINT CHIP DR
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23320-3296
Practice Address - Country:US
Practice Address - Phone:757-383-2795
Practice Address - Fax:757-216-6246
Is Sole Proprietor?:No
Enumeration Date:2023-07-17
Last Update Date:2025-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAA60611330172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver