Provider Demographics
NPI:1356454839
Name:SPARKS, TONI (DNP)
Entity Type:Individual
Prefix:
First Name:TONI
Middle Name:
Last Name:SPARKS
Suffix:
Gender:F
Credentials:DNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1940 S BONITO WAY STE 190
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83642-5618
Mailing Address - Country:US
Mailing Address - Phone:208-287-9420
Mailing Address - Fax:
Practice Address - Street 1:1111 S ORCHARD ST STE 155
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83705-1963
Practice Address - Country:US
Practice Address - Phone:208-333-0103
Practice Address - Fax:208-333-0105
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-17
Last Update Date:2023-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDNP-458A363LP0808X
IDNP458A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID1342948OtherMEDICARE
ID1356454839OtherNPI
ID1342948OtherMEDICARE
ID1342948OtherMEDICARE