Healthcare Provider Details

I. General information

NPI: 1114245107
Provider Name (Legal Business Name): DOROTHY ANN SPARKS M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/14/2010
Last Update Date: 04/20/2023
Certification Date: 04/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

311 9TH ST N STE 304
NAPLES FL
34102-5887
US

IV. Provider business mailing address

1001 E 2ND ST
COUDERSPORT PA
16915-8161
US

V. Phone/Fax

Practice location:
  • Phone: 239-624-8250
  • Fax: 239-624-8251
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberMD459013
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License NumberME114245
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: