Individual
DR. TAMMY SPARKS JENET
Active
Sole proprietor
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1860 TOWN CENTER PKWY, #G100 RESTON SURGERY CENTER, RESTON, VA 20190-3219
(703) 471-0919
(703) 742-9081
Mailing address
PO BOX 2699, RESTON, VA 20195-0699
(703) 471-0919
(703) 742-9081
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
0101054984
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
138746
ANTHEM
—
Enumeration date
12/19/2005
Last updated
07/08/2007
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