Provider Demographics
NPI:1356408728
Name:O'SULLIVAN, KATHLEEN (ARNP)
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:
Last Name:O'SULLIVAN
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 1:7400 S TAMIAMI TRL
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34231-7006
Mailing Address - Country:US
Mailing Address - Phone:941-364-8220
Mailing Address - Fax:941-952-9503
Practice Address - Street 1:1900 BROTHER GEENEN WAY
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34236-7102
Practice Address - Country:US
Practice Address - Phone:941-556-3220
Practice Address - Fax:941-955-8214
Is Sole Proprietor?:No
Enumeration Date:2007-01-03
Last Update Date:2019-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP2892202363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL500028917OtherRAILROAD MEDICARE
FLS86111Medicare UPIN
FL500028917OtherRAILROAD MEDICARE