Provider Demographics
NPI:1295734143
Name:THOMAS, ADALINE SULLIVAN (ARNP)
Entity type:Individual
Prefix:
First Name:ADALINE
Middle Name:SULLIVAN
Last Name:THOMAS
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 1:1051 GOLFSIDE DR
Mailing Address - Street 2:
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32792-5127
Mailing Address - Country:US
Mailing Address - Phone:407-677-7047
Mailing Address - Fax:
Practice Address - Street 1:618 S FOREST AVE
Practice Address - Street 2:
Practice Address - City:APOPKA
Practice Address - State:FL
Practice Address - Zip Code:32703-5338
Practice Address - Country:US
Practice Address - Phone:407-886-6201
Practice Address - Fax:407-886-3822
Is Sole Proprietor?:No
Enumeration Date:2005-07-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP 1379282363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLY5139ZMedicare ID - Type Unspecified
S00807Medicare UPIN