Provider Demographics
NPI:1447669106
Name:SPARKS, TATIANA M
Entity type:Individual
Prefix:
First Name:TATIANA
Middle Name:M
Last Name:SPARKS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 E ROBINSON ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32801-1945
Mailing Address - Country:US
Mailing Address - Phone:407-440-4509
Mailing Address - Fax:407-440-4510
Practice Address - Street 1:200 E ROBINSON ST
Practice Address - Street 2:SUITE 200
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32801-1945
Practice Address - Country:US
Practice Address - Phone:407-285-2110
Practice Address - Fax:407-440-4510
Is Sole Proprietor?:No
Enumeration Date:2014-08-07
Last Update Date:2015-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No104100000XBehavioral Health & Social Service ProvidersSocial Worker