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Individual

TIFFANY R SPARKS

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F

Contact information

Practice address
4034 N TACOMA AVE, INDIANAPOLIS, IN 46205-2921
(317) 827-4058
Mailing address
4034 N TACOMA AVE, INDIANAPOLIS, IN 46205-2921
(317) 827-4058

Taxonomy

Speciality
Code
Description
License number
State
253Z00000X
In Home Supportive Care Agency
Primary
25-018538-1
IN

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
330111758
IN
Enumeration date
06/10/2025
Last updated
06/12/2025
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