Healthcare Provider Details

I. General information

NPI: 1679240691
Provider Name (Legal Business Name): JENNIFER ANN SPARKS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/26/2021
Last Update Date: 07/26/2025
Certification Date: 07/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 ST LUKES LN
STROUDSBURG PA
18360-6217
US

IV. Provider business mailing address

150 OLD KETTLE CT
STROUDSBURG PA
18360-7145
US

V. Phone/Fax

Practice location:
  • Phone: 272-212-2300
  • Fax:
Mailing address:
  • Phone: 570-856-0801
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberSP024806
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License NumberRN678992
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: