Healthcare Provider Details

I. General information

NPI: 1679516728
Provider Name (Legal Business Name): JOHN T SULLEBARGER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/14/2006
Last Update Date: 09/13/2023
Certification Date: 09/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4200 N ARMENIA AVE SUITE 5
TAMPA FL
33607-6438
US

IV. Provider business mailing address

38135 MARKET SQ
ZEPHYRHILLS FL
33542-7505
US

V. Phone/Fax

Practice location:
  • Phone: 813-284-2200
  • Fax: 813-377-1700
Mailing address:
  • Phone: 813-528-4975
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License NumberME62629
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: