Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | ARNP1721632 | FL |
N | 363LF0000X | Nurse Practitioner - Family Medicine | ARNP1721632 | FL |
N | 363LW0102X | Nurse Practitioner - Women's Health | ARNP1721632 | FL |
NPI | 1023065877 |
---|---|
Provider Name | Lorraine Sullivan-Thompson |
First Address | Orlando, FL 32891-0001 |
Second Address | Tampa, FL 33612 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/05/2006 |
Last Update Date | 26/10/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
303642100 | (05) | FL |
P69556 | (02) | FL |
Y138K | BLUE CROSS BLUE SHIELD (01) | FL |