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NPI Code Detail

MEDICARE: MRS. NAOMI LEIGH SULLIVAN CNM

MEDICARE: MRS. NAOMI LEIGH SULLIVAN CNM
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LX0001XObstetrics & Gynecology Nurse Practitioner0024172420VA
2367A00000XAdvanced Practice MidwifeFL
3367A00000XAdvanced Practice Midwife1487050621FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1487050621
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. NAOMI LEIGH SULLIVAN CNM
Provider Business Mailing Address
First Line : 300 HEALTH PARK BLVD STE 3002
Second Line :
City : ST AUGUSTINE
State : FL
Zip : 32086-3703
Country : US
Telephone Number : 904-819-1500
Fax Number :
Provider Business Practice Location Address
First Line : 300 HEALTH PARK BLVD STE 3002
Second Line :
City : ST AUGUSTINE
State : FL
Zip : 32086-3703
Country : US
Telephone Number : 904-819-1500
Fax Number : 904-810-1023
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/17/2014
Last Update Date : 10/03/2023

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