Provider Demographics
NPI:1235433632
Name:SPARKS, UYEN NGUYEN (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:UYEN
Middle Name:NGUYEN
Last Name:SPARKS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MRS
Other - First Name:UYEN
Other - Middle Name:THAO
Other - Last Name:NGUYEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:339 WILLIAMS AVE
Mailing Address - Street 2:
Mailing Address - City:ORANGE CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32763-6002
Mailing Address - Country:US
Mailing Address - Phone:407-797-4879
Mailing Address - Fax:
Practice Address - Street 1:1414 KUHL AVE
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32806-2008
Practice Address - Country:US
Practice Address - Phone:321-841-5236
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-12-29
Last Update Date:2024-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA 9105656363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant