| NPI | 1114218542 |
|---|---|
| Doing Business As | SPARKS PEDIATRIC CLINIC |
| Entity Type | Organization |
| Authorized Contact | MICHAEL L GINGRAS Vice President 239-598-3131 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics |
| Additional Taxonomies | 363L00000X Nurse Practitioner |
| Enumeration Date | 2011-04-19 |
| Last Update Date | 2012-11-27 |