Healthcare Provider Details

I. General information

NPI: 1104452887
Provider Name (Legal Business Name): VINCENT LEE SPINOSA-PARKER NP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/13/2020
Last Update Date: 07/02/2026
Certification Date: 07/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

109 E DONALD ST STE 3
QUITMAN MS
39355-2310
US

IV. Provider business mailing address

420 HIGHWAY 80
LAKE MS
39092-9460
US

V. Phone/Fax

Practice location:
  • Phone: 601-830-5757
  • Fax:
Mailing address:
  • Phone: 901-907-9901
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number27423
License Number StateMS
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number903858
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: