Basic Information
| Provider Information | |||||||||
| NPI: | 1003009176 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SPRAGG | ||||||||
| FirstName: | CHERYL | ||||||||
| MiddleName: | A. | ||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | PA-C | ||||||||
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| 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 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | 50.002263 | OH | N | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | 363A00000X | PA9105543 | FL | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
ID Information
| ID | Type | State | Issuer | Description | Y04YJ | 01 | FL | BCBS OF FLORIDA | OTHER |