Healthcare Provider Details

I. General information

NPI: 1699026922
Provider Name (Legal Business Name): ANN M SPARKS APN, FNP, NP - C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/26/2012
Last Update Date: 04/22/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

421 N 9TH ST SUITE 240
SPRINGFIELD IL
62702-5317
US

IV. Provider business mailing address

PO BOX 19680
SPRINGFIELD IL
62794-9680
US

V. Phone/Fax

Practice location:
  • Phone: 217-545-8000
  • Fax: 217-545-8103
Mailing address:
  • Phone: 217-545-8000
  • Fax: 217-545-8103

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209-009806
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: