Provider Demographics
NPI:1144806407
Name:SULLIVAN, ASHLEY CAITLIN (RN)
Entity Type:Individual
Prefix:MS
First Name:ASHLEY
Middle Name:CAITLIN
Last Name:SULLIVAN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2500 QUANTUM LAKES DR STE 105
Mailing Address - Street 2:
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33426-8308
Mailing Address - Country:US
Mailing Address - Phone:561-502-4720
Mailing Address - Fax:833-562-8893
Practice Address - Street 1:2500 QUANTUM LAKES DR STE 105
Practice Address - Street 2:
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33426-8308
Practice Address - Country:US
Practice Address - Phone:561-502-4720
Practice Address - Fax:833-562-8893
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-18
Last Update Date:2021-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9355814163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse