Provider Demographics
NPI:1497159396
Name:SUZANNE S SPARKS
Entity Type:Organization
Organization Name:SUZANNE S SPARKS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SUZANNE
Authorized Official - Middle Name:S
Authorized Official - Last Name:SPARKS
Authorized Official - Suffix:
Authorized Official - Credentials:CRNA
Authorized Official - Phone:817-946-3397
Mailing Address - Street 1:101 BIG OAK LN
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:TX
Mailing Address - Zip Code:78633-6603
Mailing Address - Country:US
Mailing Address - Phone:817-946-3397
Mailing Address - Fax:
Practice Address - Street 1:101 BIG OAK LN
Practice Address - Street 2:
Practice Address - City:GEORGETOWN
Practice Address - State:TX
Practice Address - Zip Code:78633-6603
Practice Address - Country:US
Practice Address - Phone:817-946-3397
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-21
Last Update Date:2014-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXARPN547197367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty