Provider Demographics
NPI:1104452887
Name:SPINOSA-PARKER, VINCENT LEE (NP-C)
Entity type:Individual
Prefix:
First Name:VINCENT
Middle Name:LEE
Last Name:SPINOSA-PARKER
Suffix:
Gender:M
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2670 MCINGVALE RD
Mailing Address - Street 2:STE H
Mailing Address - City:HERNANDO
Mailing Address - State:MS
Mailing Address - Zip Code:38632-8695
Mailing Address - Country:US
Mailing Address - Phone:901-907-9901
Mailing Address - Fax:
Practice Address - Street 1:5056 MAIDEN LANE CV
Practice Address - Street 2:
Practice Address - City:SOUTHAVEN
Practice Address - State:MS
Practice Address - Zip Code:38672-6000
Practice Address - Country:US
Practice Address - Phone:901-907-9901
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-13
Last Update Date:2021-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS903858363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily