Provider Demographics
NPI:1750909420
Name:SPARKMAN, ADAM (APRN)
Entity type:Individual
Prefix:
First Name:ADAM
Middle Name:
Last Name:SPARKMAN
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1729 TRILLIUM BLVD
Mailing Address - Street 2:
Mailing Address - City:BROOKSVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:34604-5370
Mailing Address - Country:US
Mailing Address - Phone:352-584-8920
Mailing Address - Fax:
Practice Address - Street 1:1729 TRILLIUM BLVD
Practice Address - Street 2:
Practice Address - City:BROOKSVILLE
Practice Address - State:FL
Practice Address - Zip Code:34604-5370
Practice Address - Country:US
Practice Address - Phone:352-584-8920
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-09
Last Update Date:2020-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11006542363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner