Provider Demographics
NPI:1790926194
Name:SULLIVAN-TAYLOR, LOIS (ARNP)
Entity Type:Individual
Prefix:MS
First Name:LOIS
Middle Name:
Last Name:SULLIVAN-TAYLOR
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 WEST SAMPLE ROAD
Mailing Address - Street 2:SUITE 205
Mailing Address - City:POMPANO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33064
Mailing Address - Country:US
Mailing Address - Phone:954-786-2255
Mailing Address - Fax:954-786-7146
Practice Address - Street 1:1 W SAMPLE RD
Practice Address - Street 2:STE 205
Practice Address - City:POMPANO BEACH
Practice Address - State:FL
Practice Address - Zip Code:33064-3547
Practice Address - Country:US
Practice Address - Phone:954-786-2255
Practice Address - Fax:954-786-7146
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-13
Last Update Date:2009-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL2701732363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner