MEDICARE: MRS. ELIZABETH JO SPARKMAN APRN

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	363LF0000X	Family Nurse Practitioner	A183377	IA
2	363LF0000X	Family Nurse Practitioner	002491186	VA
3	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	AP128615	TX
4	363LF0000X	Family Nurse Practitioner	AP128615	TX

General Provider Information

NPI Number	:	1548645047
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ELIZABETH JO SPARKMAN APRN

Provider Business Mailing Address
First Line	:	18615 TUSCANY STONE STE 250
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78258-3504
Country	:	US
Telephone Number	:	726-207-5519
Fax Number	:	726-245-0052

Provider Business Practice Location Address
First Line	:	18615 TUSCANY STONE STE 250
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78258-3504
Country	:	US
Telephone Number	:	726-207-5519
Fax Number	:	726-245-0052

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

Provider Enumeration Date	:	07/25/2015
Last Update Date	:	11/07/2025

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