Healthcare Provider Details

I. General information

NPI: 1154056414
Provider Name (Legal Business Name): SULY BREA APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2022
Last Update Date: 06/30/2026
Certification Date: 06/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 W SAMPLE RD STE 204
DEERFIELD BEACH FL
33064-3547
US

IV. Provider business mailing address

1608 SE 3RD AVE FL 3
FORT LAUDERDALE FL
33316-2564
US

V. Phone/Fax

Practice location:
  • Phone: 954-785-0300
  • Fax: 954-785-0229
Mailing address:
  • Phone: 954-785-0300
  • Fax: 954-785-0229

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number11020901
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: