Basic Information
Provider Information
NPI: 1003009176
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: SPRAGG
FirstName: CHERYL
MiddleName: A.
NamePrefix: MS.
NameSuffix:  
Credential: PA-C
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1150 SW GOODMAN AVE
Address2:  
City: PORT ST LUCIE
State: FL
PostalCode: 349531433
CountryCode: US
TelephoneNumber: 9373608152
FaxNumber: 7723379034
Practice Location
Address1: 2100 SE OCEAN BLVD
Address2: SUITE 100
City: STUART
State: FL
PostalCode: 349963332
CountryCode: US
TelephoneNumber: 7722232115
FaxNumber: 7723379034
Other Information
ProviderEnumerationDate: 08/22/2007
LastUpdateDate: 08/23/2011
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363A00000XPA9105543FLY Physician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant 
363A00000X50.002263OHN Physician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant 

ID Information
IDTypeStateIssuerDescription
Y04YJ01FLBCBS OF FLORIDAOTHER


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