Provider Demographics
NPI:1376857011
Name:SPARTA, TIMOTHY NOBLE (PA-C)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:NOBLE
Last Name:SPARTA
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35247 ATLANTIC AVE UNIT 1
Mailing Address - Street 2:
Mailing Address - City:MILLVILLE
Mailing Address - State:DE
Mailing Address - Zip Code:19967-6912
Mailing Address - Country:US
Mailing Address - Phone:302-829-1015
Mailing Address - Fax:302-829-1016
Practice Address - Street 1:35247 ATLANTIC AVE UNIT 1
Practice Address - Street 2:
Practice Address - City:MILLVILLE
Practice Address - State:DE
Practice Address - Zip Code:19967-6912
Practice Address - Country:US
Practice Address - Phone:302-829-1015
Practice Address - Fax:302-819-1016
Is Sole Proprietor?:No
Enumeration Date:2010-08-05
Last Update Date:2024-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDC0004266363A00000X
DEC50000957363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant