Provider Demographics
NPI:1275008799
Name:SULLIVAN, PATRICK (AP 239)
Entity Type:Individual
Prefix:
First Name:PATRICK
Middle Name:
Last Name:SULLIVAN
Suffix:
Gender:M
Credentials:AP 239
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:114 E TARPON AVE # 2
Mailing Address - Street 2:
Mailing Address - City:TARPON SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:34689-3452
Mailing Address - Country:US
Mailing Address - Phone:727-942-4249
Mailing Address - Fax:727-258-2558
Practice Address - Street 1:9 HIBISCUS ST STE 5
Practice Address - Street 2:
Practice Address - City:TARPON SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:34689-3436
Practice Address - Country:US
Practice Address - Phone:727-942-4249
Practice Address - Fax:727-258-2558
Is Sole Proprietor?:No
Enumeration Date:2018-10-11
Last Update Date:2018-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP239171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist