Provider Demographics
NPI:1467521641
Name:SPARKS, JAN C (ACNP-BC)
Entity Type:Individual
Prefix:MRS
First Name:JAN
Middle Name:C
Last Name:SPARKS
Suffix:
Gender:F
Credentials:ACNP-BC
Other - Prefix:MISS
Other - First Name:JAN
Other - Middle Name:C
Other - Last Name:JACKSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ACNP-BC
Mailing Address - Street 1:1645 MURFREESBORO PIKE
Mailing Address - Street 2:SUITE H
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37217-2936
Mailing Address - Country:US
Mailing Address - Phone:615-891-7444
Mailing Address - Fax:615-742-0902
Practice Address - Street 1:1645 MURFREESBORO PIKE
Practice Address - Street 2:SUITE H
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37217-2936
Practice Address - Country:US
Practice Address - Phone:615-891-7444
Practice Address - Fax:615-742-0902
Is Sole Proprietor?:No
Enumeration Date:2006-11-06
Last Update Date:2013-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN7184363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
P22135Medicare UPIN