Healthcare Provider Details

I. General information

NPI: 1669201315
Provider Name (Legal Business Name): TONYA SULLIVAN APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/31/2024
Last Update Date: 07/31/2024
Certification Date: 07/31/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6440 W NEWBERRY RD STE 409
GAINESVILLE FL
32605-4370
US

IV. Provider business mailing address

6440 W NEWBERRY RD STE 409
GAINESVILLE FL
32605-4370
US

V. Phone/Fax

Practice location:
  • Phone: 352-333-6161
  • Fax: 352-333-6162
Mailing address:
  • Phone: 352-333-6161
  • Fax: 352-333-6162

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPRN11034412
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: