Provider Demographics
NPI:1811254535
Name:SPRAGUE, EVELINA (DO)
Entity type:Individual
Prefix:
First Name:EVELINA
Middle Name:
Last Name:SPRAGUE
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 15527
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34277-1527
Mailing Address - Country:US
Mailing Address - Phone:757-375-8171
Mailing Address - Fax:888-972-9784
Practice Address - Street 1:6150 EDGELAKE DR
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34240-8803
Practice Address - Country:US
Practice Address - Phone:757-375-8171
Practice Address - Fax:888-972-9784
Is Sole Proprietor?:No
Enumeration Date:2012-04-19
Last Update Date:2024-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS15541208M00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist