Provider Demographics
NPI:1235145749
Name:SULLIVAN, PATRICIA A (NP)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:A
Last Name:SULLIVAN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:PATRICIA
Other - Middle Name:A
Other - Last Name:SCHUMACHER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 102222
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30368-2222
Mailing Address - Country:US
Mailing Address - Phone:239-274-8200
Mailing Address - Fax:
Practice Address - Street 1:714 DOCTORS DR
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD
Practice Address - State:FL
Practice Address - Zip Code:34223-3992
Practice Address - Country:US
Practice Address - Phone:941-460-1300
Practice Address - Fax:866-504-3674
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2024-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP2240652163WX0200X, 363L00000X
NC5004742363L00000X
NC235720363L00000X
WAAP60914128363L00000X
FLAPRN11027963363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WX0200XNursing Service ProvidersRegistered NurseOncology
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1235145749Medicaid
NC7005049Medicaid
SCNP1731Medicaid
FLP00626898OtherMEDICARE RR
FL306951600Medicaid
FLP00626898OtherMEDICARE RR
NC1235145749Medicaid
NC2595082Medicare PIN