Provider Demographics
NPI:1881741551
Name:SPARKS, SUZANNE S (CRNA)
Entity type:Individual
Prefix:
First Name:SUZANNE
Middle Name:S
Last Name:SPARKS
Suffix:
Gender:
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 BIG OAK LN
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:TX
Mailing Address - Zip Code:78633-6603
Mailing Address - Country:US
Mailing Address - Phone:817-946-3397
Mailing Address - Fax:
Practice Address - Street 1:101 BIG OAK LN
Practice Address - Street 2:
Practice Address - City:GEORGETOWN
Practice Address - State:TX
Practice Address - Zip Code:78633-6603
Practice Address - Country:US
Practice Address - Phone:817-946-3397
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-04
Last Update Date:2025-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX547197367500000X
OK87671367500000X
TXAP115745367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered