Provider Demographics
NPI:1881104495
Name:SPRATLIN, SONIA A
Entity type:Individual
Prefix:
First Name:SONIA
Middle Name:A
Last Name:SPRATLIN
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 1:3049 CLEVELAND AVE STE 263
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33901-7047
Mailing Address - Country:US
Mailing Address - Phone:239-747-8688
Mailing Address - Fax:
Practice Address - Street 1:12557 NEW BRITTANY BLVD STE 3V97
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33907-3651
Practice Address - Country:US
Practice Address - Phone:233-747-8688
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-09
Last Update Date:2024-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171W00000X, 376J00000X
FLL4Q7X4N3246RP1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomyGroup - Multi-Specialty
No171W00000XOther Service ProvidersContractor
No376J00000XNursing Service Related ProvidersHomemaker