Provider Demographics
NPI:1508351024
Name:SULLIVAN, ATINA LORENE (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:DR
First Name:ATINA
Middle Name:LORENE
Last Name:SULLIVAN
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:ATINA
Other - Middle Name:L
Other - Last Name:COVINGTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3205 DORSTONE PL
Mailing Address - Street 2:
Mailing Address - City:UPPER MARLBORO
Mailing Address - State:MD
Mailing Address - Zip Code:20774-8099
Mailing Address - Country:US
Mailing Address - Phone:313-673-6928
Mailing Address - Fax:
Practice Address - Street 1:1202 ANNAPOLIS RD
Practice Address - Street 2:
Practice Address - City:ODENTON
Practice Address - State:MD
Practice Address - Zip Code:21113-1397
Practice Address - Country:US
Practice Address - Phone:410-672-2862
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-27
Last Update Date:2023-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR250751363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health