Provider Demographics
NPI:1427531961
Name:SPARBER, JACQUELINE SANTANA (PSYD)
Entity type:Individual
Prefix:DR
First Name:JACQUELINE
Middle Name:SANTANA
Last Name:SPARBER
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14213 SW 289TH TER
Mailing Address - Street 2:
Mailing Address - City:HOMESTEAD
Mailing Address - State:FL
Mailing Address - Zip Code:33033-2989
Mailing Address - Country:US
Mailing Address - Phone:305-409-6679
Mailing Address - Fax:
Practice Address - Street 1:14213 SW 289TH TER
Practice Address - Street 2:
Practice Address - City:HOMESTEAD
Practice Address - State:FL
Practice Address - Zip Code:33033-2989
Practice Address - Country:US
Practice Address - Phone:305-409-6679
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-11
Last Update Date:2024-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103T00000X
FLPY10535103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist