Healthcare Provider Details

I. General information

NPI: 1841053576
Provider Name (Legal Business Name): JOANNE SPARKS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/05/2024
Last Update Date: 02/05/2024
Certification Date: 02/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 NW FEDERAL HWY
STUART FL
34994-1005
US

IV. Provider business mailing address

584 NE CANOE PARK CIR
PORT SAINT LUCIE FL
34983-3510
US

V. Phone/Fax

Practice location:
  • Phone: 772-497-0049
  • Fax:
Mailing address:
  • Phone: 813-340-9514
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: