Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2081S0010X | Sports Medicine | PT29724 | FL |
Y | 213ES0000X | Sports Medicine | PT29724 | FL |
NPI | 1215339064 |
---|---|
Provider Name | Frankie Sparacia |
First Address | Ponte Vedra Beach, FL 32082-6619 |
Second Address | Ponte Vedra Beach, FL 32082-6619 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/09/2014 |
Last Update Date | 24/09/2014 |