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General NPI Number Information
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NPI Number | 1700607868
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Entity Type | Individual
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Provider Name | CAITLIN CRIDER SULLIVAN FNP-C
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Gender | Female
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Dates
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Enumeration Date | 10/22/2024
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Last Update Date | 10/22/2024
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Provider Practice Location Address
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Address Line | 10706 MARLBORO AVE
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City | BARNWELL
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State | SC
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Zip | 29812-6376
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Country | US
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Telephone | 803-259-7337
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Fax | 803-259-9505
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Provider Business Mailing Address
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Address Line | 86 WREN ST
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City | BARNWELL
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State | SC
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Zip | 29812-1529
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Country | US
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Telephone | 803-259-5762
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Fax | 803-259-3250
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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 | F10240912
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License Number State | SC
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