Provider Demographics
NPI:1154946572
Name:SPARKS-FREEMONT, RIDA (APRN, FNP-BC)
Entity type:Individual
Prefix:
First Name:RIDA
Middle Name:
Last Name:SPARKS-FREEMONT
Suffix:
Gender:
Credentials:APRN, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2310 WADE HAMPTON BLVD
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29615-1043
Mailing Address - Country:US
Mailing Address - Phone:864-292-5915
Mailing Address - Fax:864-244-7734
Practice Address - Street 1:2310 WADE HAMPTON BLVD
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29615-1043
Practice Address - Country:US
Practice Address - Phone:864-292-5915
Practice Address - Fax:864-244-7734
Is Sole Proprietor?:No
Enumeration Date:2020-06-11
Last Update Date:2025-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC24279363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily