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General NPI Number Information
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NPI Number | 1316021009
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Entity Type | Individual
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Provider Name | JENNIFER A SULLIVAN NP
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Gender | Female
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Dates
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Enumeration Date | 10/25/2006
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Last Update Date | 05/10/2013
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Provider Practice Location Address
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Address Line | 1700 S. TAMIAMI TRAIL VALVE CLINIC
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City | SARASOTA
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State | FL
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Zip | 34233-3509
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Country | US
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Telephone | 941-917-6968
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Fax | 941-917-5437
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Provider Business Mailing Address
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Address Line | 1700 S. TAMIAMI TRAIL VALVE CLINIC
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City | SARASOTA
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State | FL
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Zip | 34233-3509
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Country | US
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Telephone | 941-917-6968
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Fax | 941-917-5437
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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 | 363LA2100X
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Taxonomy Name | Acute Care Nurse Practitioner
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License Number | 209006344
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License Number State | IL
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