Provider Demographics
NPI:1477527182
Name:SULLIVAN, TANYA CHRISTINE (APRN, MSN, CNP)
Entity Type:Individual
Prefix:
First Name:TANYA
Middle Name:CHRISTINE
Last Name:SULLIVAN
Suffix:
Gender:F
Credentials:APRN, MSN, CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:BOX 1928
Mailing Address - Street 2:13 BROWN STREET ANDREWS HOUSE
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02912
Mailing Address - Country:US
Mailing Address - Phone:508-359-5909
Mailing Address - Fax:
Practice Address - Street 1:13 BROWN STREET ANDREWS HOUSE
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02912
Practice Address - Country:US
Practice Address - Phone:617-287-8000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-17
Last Update Date:2019-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA238094363LF0000X
RIAPRN01714363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily