Provider Demographics
NPI:1518854751
Name:SPARKS, JESSICA (PARAMEDICAL TATTOO)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:SPARKS
Suffix:
Gender:F
Credentials:PARAMEDICAL TATTOO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:316 4TH AVE NE
Mailing Address - Street 2:
Mailing Address - City:SARTELL
Mailing Address - State:MN
Mailing Address - Zip Code:56377-1315
Mailing Address - Country:US
Mailing Address - Phone:320-309-1742
Mailing Address - Fax:
Practice Address - Street 1:120 DIVISION ST
Practice Address - Street 2:
Practice Address - City:SAUK RAPIDS
Practice Address - State:MN
Practice Address - Zip Code:56379-1424
Practice Address - Country:US
Practice Address - Phone:320-291-1701
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-20
Last Update Date:2025-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN312450156F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156F00000XEye and Vision Services ProvidersTechnician/Technologist