Healthcare Provider Details

I. General information

NPI: 1053502898
Provider Name (Legal Business Name): ELIZABETH ANNE SPARKS RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/07/2007
Last Update Date: 08/07/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3718 NOLENSVILLE PIKE
NASHVILLE TN
37211-3302
US

IV. Provider business mailing address

113 WALKING HORSE CT
NASHVILLE TN
37211-6820
US

V. Phone/Fax

Practice location:
  • Phone: 615-880-2200
  • Fax:
Mailing address:
  • Phone: 615-332-0411
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License NumberRN00001411118
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: