Provider Demographics
NPI:1518613694
Name:SULLIVAN, COURTNEY ELIZABETH (RN)
Entity Type:Individual
Prefix:
First Name:COURTNEY
Middle Name:ELIZABETH
Last Name:SULLIVAN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2691 ALBATROSS RD N APT 203
Mailing Address - Street 2:
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33444-2090
Mailing Address - Country:US
Mailing Address - Phone:708-299-4794
Mailing Address - Fax:
Practice Address - Street 1:421 N 21ST AVE
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33020-4013
Practice Address - Country:US
Practice Address - Phone:305-899-4722
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-27
Last Update Date:2022-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041394745163W00000X
FL9579641163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse