Provider Demographics
NPI:1306312624
Name:SPRINKLE, SAMUEL
Entity type:Individual
Prefix:
First Name:SAMUEL
Middle Name:
Last Name:SPRINKLE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2325 MYRA ST APT 2
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32204-3630
Mailing Address - Country:US
Mailing Address - Phone:740-935-9240
Mailing Address - Fax:740-529-0385
Practice Address - Street 1:12724 GRAN BAY PKWY W STE 410
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32258-9486
Practice Address - Country:US
Practice Address - Phone:740-935-9240
Practice Address - Fax:740-529-0385
Is Sole Proprietor?:No
Enumeration Date:2018-10-15
Last Update Date:2023-03-20
Deactivation Date:2023-03-08
Deactivation Code:
Reactivation Date:2023-03-14
Provider Licenses
StateLicense IDTaxonomies
FL1-22-60251103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst