Provider Demographics
NPI:1518239078
Name:SPRAKER, CORTNEY LEE (MS, PA-C)
Entity type:Individual
Prefix:
First Name:CORTNEY
Middle Name:LEE
Last Name:SPRAKER
Suffix:
Gender:F
Credentials:MS, PA-C
Other - Prefix:
Other - First Name:CORTNEY
Other - Middle Name:LEE
Other - Last Name:GREEN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MS, PA-C
Mailing Address - Street 1:34467 VIA VERDE
Mailing Address - Street 2:
Mailing Address - City:CAPISTRANO BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92624-1238
Mailing Address - Country:US
Mailing Address - Phone:949-233-4763
Mailing Address - Fax:
Practice Address - Street 1:1301 20TH ST STE 440
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90404-2109
Practice Address - Country:US
Practice Address - Phone:310-208-0474
Practice Address - Fax:310-208-0374
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-30
Last Update Date:2012-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA 20680363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical