MEDICARE: SPARKS TRANSIT

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	347E00000X	Transportation Broker

General Provider Information

NPI Number	:	1740962703
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SPARKS TRANSIT

Provider Business Mailing Address
First Line	:	PO BOX 4712
Second Line	:
City	:	HOLLYWOOD
State	:	FL
Zip	:	33083-4712
Country	:	US
Telephone Number	:	561-770-2734
Fax Number	:

Provider Business Practice Location Address
First Line	:	405 FIFTH AVE S STE 7
Second Line	:
City	:	NAPLES
State	:	FL
Zip	:	34102-6515
Country	:	US
Telephone Number	:	561-770-2734
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR
Name	:	TAMMY SPARKS
Credential	:
Telephone Number	:	561-770-2734

Provider Enumeration Date	:	08/01/2023
Last Update Date	:	08/01/2023

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Directions to “SPARKS TRANSIT ” Practice Location

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