Provider Demographics
NPI:1669201315
Name:SULLIVAN, TONYA (APRN)
Entity type:Individual
Prefix:
First Name:TONYA
Middle Name:
Last Name:SULLIVAN
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6440 W NEWBERRY RD STE 409
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32605-4370
Mailing Address - Country:US
Mailing Address - Phone:352-333-6161
Mailing Address - Fax:352-333-6162
Practice Address - Street 1:6440 W NEWBERRY RD STE 409
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32605-4370
Practice Address - Country:US
Practice Address - Phone:352-333-6161
Practice Address - Fax:352-333-6162
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-31
Last Update Date:2024-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11034412363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner