Provider Demographics
NPI:1922885136
Name:SPARKS, DANA (PA-C, ATC)
Entity Type:Individual
Prefix:
First Name:DANA
Middle Name:
Last Name:SPARKS
Suffix:
Gender:F
Credentials:PA-C, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7524 DARTMOOR DR
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32514-4513
Mailing Address - Country:US
Mailing Address - Phone:407-719-9225
Mailing Address - Fax:
Practice Address - Street 1:1110 AIRPORT BLVD STE B
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32504-8649
Practice Address - Country:US
Practice Address - Phone:850-438-1136
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-11
Last Update Date:2023-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical