Provider Demographics
NPI:1437471778
Name:SULLIVAN, NANCY J (FNP)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:J
Last Name:SULLIVAN
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7885 N ORACLE RD
Mailing Address - Street 2:
Mailing Address - City:ORO VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:85704-6348
Mailing Address - Country:US
Mailing Address - Phone:520-232-5280
Mailing Address - Fax:520-232-5299
Practice Address - Street 1:1323 W PRINCE RD
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85705-3114
Practice Address - Country:US
Practice Address - Phone:520-887-0800
Practice Address - Fax:520-887-1393
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-26
Last Update Date:2016-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN135312163W00000X
AZAP3540363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ499768Medicaid