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General NPI Number Information
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NPI Number | 1134677842
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Entity Type | Individual
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Provider Name | MICHELLE B SULLIVAN ARNP
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Gender | Female
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Dates
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Enumeration Date | 09/12/2016
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Last Update Date | 07/20/2021
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Provider Practice Location Address
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Address Line | 3292 COUNTY ROAD 220
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City | MIDDLEBURG
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State | FL
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Zip | 32068-4357
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Country | US
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Telephone | 904-291-5561
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Fax |
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Provider Business Mailing Address
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Address Line | 3292 COUNTY ROAD 220
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City | MIDDLEBURG
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State | FL
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Zip | 32068-4357
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Country | US
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Telephone | 904-291-5561
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | ARNP3144812
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | APRN3144812
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License Number State | FL
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