Provider Demographics
NPI:1285017616
Name:MARTIN, EMILY SULLIVAN (ARNP)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:SULLIVAN
Last Name:MARTIN
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:EMILY
Other - Middle Name:ELLEN
Other - Last Name:SULLIVAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:ARNP
Mailing Address - Street 1:PO BOX 100223
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32610-0223
Mailing Address - Country:US
Mailing Address - Phone:352-265-0665
Mailing Address - Fax:352-265-0057
Practice Address - Street 1:1600 SW ARCHER RD
Practice Address - Street 2:PEDIATRIC HEART AND LUNG TRANSPLANT
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32610-0223
Practice Address - Country:US
Practice Address - Phone:352-265-0665
Practice Address - Fax:352-265-0057
Is Sole Proprietor?:No
Enumeration Date:2015-07-02
Last Update Date:2017-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9308027363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL016017000Medicaid
FL016017000Medicaid