Healthcare Provider Details

I. General information

NPI: 1235825548
Provider Name (Legal Business Name): EMILY ELIZABETH SULLIVAN APRN-CRNA DNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MISS EMILY ELIZABETH KIRKHAM

II. Dates (important events)

Enumeration Date: 04/11/2023
Last Update Date: 03/26/2024
Certification Date: 03/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5030 BRUNSON DR
CORAL GABLES FL
33146-2412
US

IV. Provider business mailing address

896 OAK DR
MARION OH
43302-8468
US

V. Phone/Fax

Practice location:
  • Phone: 305-284-3666
  • Fax:
Mailing address:
  • Phone: 740-341-2655
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN.438474
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number4704410275
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: