Healthcare Provider Details

I. General information

NPI: 1518498062
Provider Name (Legal Business Name): HAILEY LYNN LA ROCQUE SPARACINO DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: HAILEY LYNN LA ROCQUE PETERSON

II. Dates (important events)

Enumeration Date: 03/27/2017
Last Update Date: 07/09/2026
Certification Date: 07/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2950 PINE PLANTATION PKWY
OAK ISLAND NC
28461-0119
US

IV. Provider business mailing address

PO BOX 60447
CHARLOTTE NC
28260-0447
US

V. Phone/Fax

Practice location:
  • Phone: 910-454-4032
  • Fax: 910-454-4033
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number2020-01879
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number2020-01879
License Number StateNC
# 4
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number0102206898
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: