Provider Demographics
NPI:1285043885
Name:SPARKS, JANE (APRN)
Entity Type:Individual
Prefix:
First Name:JANE
Middle Name:
Last Name:SPARKS
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:380 WEST 100 NORTH
Mailing Address - Street 2:SUITE A
Mailing Address - City:MONTICELLO
Mailing Address - State:UT
Mailing Address - Zip Code:84535-1054
Mailing Address - Country:US
Mailing Address - Phone:435-587-5054
Mailing Address - Fax:435-587-3495
Practice Address - Street 1:380 WEST 100 NORTH
Practice Address - Street 2:SUITE A
Practice Address - City:MONTICELLO
Practice Address - State:UT
Practice Address - Zip Code:84535-1054
Practice Address - Country:US
Practice Address - Phone:435-587-5054
Practice Address - Fax:435-587-3495
Is Sole Proprietor?:No
Enumeration Date:2014-08-07
Last Update Date:2014-08-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
UT67918724405363LF0000X
UT67918728900363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily