Provider Demographics
NPI:1033794029
Name:SPARKS, TONYA MAE
Entity Type:Individual
Prefix:
First Name:TONYA
Middle Name:MAE
Last Name:SPARKS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15249 PRESTON RD APT 1094
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75248-4820
Mailing Address - Country:US
Mailing Address - Phone:817-986-2829
Mailing Address - Fax:
Practice Address - Street 1:15249 PRESTON RD APT 1094
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75248-4820
Practice Address - Country:US
Practice Address - Phone:817-986-2829
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-11
Last Update Date:2021-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX3747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant