Provider Demographics
NPI:1508967290
Name:SPARKS, MARY SUE (RPSGT/ CRT)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:SUE
Last Name:SPARKS
Suffix:
Gender:F
Credentials:RPSGT/ CRT
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:7360 188TH PL
Mailing Address - Street 2:
Mailing Address - City:MC ALPIN
Mailing Address - State:FL
Mailing Address - Zip Code:32062-2757
Mailing Address - Country:US
Mailing Address - Phone:386-288-8586
Mailing Address - Fax:
Practice Address - Street 1:1601 SW ARCHER RD
Practice Address - Street 2:SLEEP LAB # 111
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32608-1135
Practice Address - Country:US
Practice Address - Phone:352-376-1611
Practice Address - Fax:352-379-4155
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLTT8225227800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes227800000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, Certified