Provider Demographics
NPI:1972726818
Name:SPARICH, THERESA JOAN (RN)
Entity Type:Individual
Prefix:MRS
First Name:THERESA
Middle Name:JOAN
Last Name:SPARICH
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8332 E DESERT STEPPES DR
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85710-4206
Mailing Address - Country:US
Mailing Address - Phone:520-721-1501
Mailing Address - Fax:
Practice Address - Street 1:1573 W AJO WAY
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85713-5738
Practice Address - Country:US
Practice Address - Phone:520-908-4047
Practice Address - Fax:520-908-4001
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-10
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN082670163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ834293Medicaid