Provider Demographics
NPI:1699026922
Name:SPARKS, ANN M (APN, FNP, NP - C)
Entity Type:Individual
Prefix:MS
First Name:ANN
Middle Name:M
Last Name:SPARKS
Suffix:
Gender:F
Credentials:APN, FNP, NP - C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 19680
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62794-9680
Mailing Address - Country:US
Mailing Address - Phone:217-545-8000
Mailing Address - Fax:217-545-8103
Practice Address - Street 1:421 N 9TH ST
Practice Address - Street 2:SUITE 240
Practice Address - City:SPRINGFIELD
Practice Address - State:IL
Practice Address - Zip Code:62702-5317
Practice Address - Country:US
Practice Address - Phone:217-545-8000
Practice Address - Fax:217-545-8103
Is Sole Proprietor?:No
Enumeration Date:2012-09-26
Last Update Date:2013-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209-009806363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL$$$$$$$$$001Medicaid
IL522000025Medicare PIN