MEDICARE: ELIZABETH 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	363LF0000X	Family Nurse Practitioner	APN.1000220-NP	CO

General Provider Information

NPI Number	:	1619791266
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELIZABETH SPARKS

Provider Business Mailing Address
First Line	:	5049 LONZO DR
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80924-5352
Country	:	US
Telephone Number	:	719-205-9895
Fax Number	:

Provider Business Practice Location Address
First Line	:	5049 LONZO DR
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80924-5352
Country	:	US
Telephone Number	:	719-205-9895
Fax Number	:

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

Provider Enumeration Date	:	11/11/2024
Last Update Date	:	11/11/2024

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