MEDICARE: TAMMY SPARKS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	343900000X	Non-emergency Medical Transport (VAN)

General Provider Information

NPI Number	:	1154014694
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TAMMY SPARKS

Provider Business Mailing Address
First Line	:	PO BOX 4712
Second Line	:
City	:	HOLLYWOOD
State	:	FL
Zip	:	33083-4712
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	433 PLAZA REAL
Second Line	:
City	:	BOCA RATON
State	:	FL
Zip	:	33432-3932
Country	:	US
Telephone Number	:	561-770-2734
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/31/2023
Last Update Date	:	05/31/2023

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Directions to “ TAMMY SPARKS ” Practice Location

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