Provider Demographics
NPI:1699042150
Name:SULLIVAN, JENNIFER N (NP)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:N
Last Name:SULLIVAN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3555 OLENTANGY RIVER RD
Mailing Address - Street 2:STE 1010
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43214-3901
Mailing Address - Country:US
Mailing Address - Phone:614-566-4907
Mailing Address - Fax:614-566-8015
Practice Address - Street 1:4995 BRADENTON AVE
Practice Address - Street 2:STE. 130
Practice Address - City:DUBLIN
Practice Address - State:OH
Practice Address - Zip Code:43017-3543
Practice Address - Country:US
Practice Address - Phone:614-734-5000
Practice Address - Fax:614-734-5001
Is Sole Proprietor?:No
Enumeration Date:2011-11-28
Last Update Date:2018-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2010015962363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner