Provider Demographics
NPI:1326180712
Name:SULLIVAN, LINDA M (DSN, RN, ARNP)
Entity Type:Individual
Prefix:DR
First Name:LINDA
Middle Name:M
Last Name:SULLIVAN
Suffix:
Gender:F
Credentials:DSN, RN, ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3129 BARINGER HILL DR
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32311-3633
Mailing Address - Country:US
Mailing Address - Phone:850-877-9709
Mailing Address - Fax:850-644-7660
Practice Address - Street 1:1633 PHYSICIANS DR
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32308-4620
Practice Address - Country:US
Practice Address - Phone:850-877-1162
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9223470363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner