Provider Demographics
NPI:1225528490
Name:JOPLIN, TASHA NICOLE SPARKS (MD)
Entity Type:Individual
Prefix:
First Name:TASHA
Middle Name:NICOLE SPARKS
Last Name:JOPLIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:TASHA
Other - Middle Name:NICOLE
Other - Last Name:SPARKS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:545 BARNHILL DRIVE
Mailing Address - Street 2:EMERSON HALL 125
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46202-5112
Mailing Address - Country:US
Mailing Address - Phone:317-274-4966
Mailing Address - Fax:317-274-8769
Practice Address - Street 1:545 BARNHILL DRIVE
Practice Address - Street 2:EMERSON HALL 125
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46202
Practice Address - Country:US
Practice Address - Phone:317-274-4966
Practice Address - Fax:317-274-8769
Is Sole Proprietor?:No
Enumeration Date:2018-05-14
Last Update Date:2018-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
IN11020111A208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program