Healthcare Provider Details

I. General information

NPI: 1275471161
Provider Name (Legal Business Name): ANNA MARIE SULLIVAN RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2026
Last Update Date: 03/23/2026
Certification Date: 03/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5301 E GRANT RD
TUCSON AZ
85712-2874
US

IV. Provider business mailing address

10640 E OAKBROOK ST
TUCSON AZ
85747-5970
US

V. Phone/Fax

Practice location:
  • Phone: 520-324-5600
  • Fax:
Mailing address:
  • Phone: 520-324-5600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License NumberRN135446
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: