Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
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Mrs. Nicole Lisa Sparks, PA-C

Individual provider Physician Assistant · NPI 1093203697

Mrs. Nicole Lisa Sparks, PA-C is a Physician Assistant in Eglin AFB, Florida. Registered with an NPI since 2018.

In the registry since
2018
Specialties on file
2
What do these letters mean?
PA-C — Physician Assistant, Certified
A physician assistant who holds current national certification.

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Practice location Address checks out

307 Boatner Rd Ste 114
Eglin AFB, FL 32542-1302
Phone: (850) 883-8600
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Surgical Physician Assistant (primary) Taxonomy 363AS0400X
Physician Assistant Taxonomy 363A00000X

Record details

NPI number1093203697
Entity typeIndividual (Type 1)
GenderFemale
Credentials PA-C
Sole proprietorNo
NPI enumeratedApril 29, 2018
Last updated in NPPESAugust 1, 2024
Certification dateAugust 1, 2024

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