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General NPI Number Information
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NPI Number | 1104452887
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Entity Type | Individual
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Provider Name | VINCENT LEE SPINOSA-PARKER NP-C
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Gender | Male
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Dates
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Enumeration Date | 03/13/2020
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Last Update Date | 07/09/2021
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Provider Practice Location Address
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Address Line | 5056 MAIDEN LANE CV
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City | SOUTHAVEN
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State | MS
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Zip | 38672-6000
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Country | US
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Telephone | 901-907-9901
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Fax |
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Provider Business Mailing Address
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Address Line | 2670 MCINGVALE RD STE H
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City | HERNANDO
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State | MS
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Zip | 38632-8695
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Country | US
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Telephone | 901-907-9901
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 903858
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License Number State | MS
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