Provider Demographics
NPI:1881762573
Name:SPRENGER, CRAIG (PA-C)
Entity type:Individual
Prefix:
First Name:CRAIG
Middle Name:
Last Name:SPRENGER
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1398 SW 18TH ST
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33486-6634
Mailing Address - Country:US
Mailing Address - Phone:561-395-6823
Mailing Address - Fax:561-395-6823
Practice Address - Street 1:1398 SW 18TH ST
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33486-6634
Practice Address - Country:US
Practice Address - Phone:561-395-6823
Practice Address - Fax:561-395-6823
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-01
Last Update Date:2007-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA1816363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPA1816OtherLICENSE
FLS62049Medicare UPIN
FLE1136WMedicare ID - Type Unspecified