Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363LA2100X | Nurse Practitioner - Acute Care | 23279 | SC |
N | 363LA2100X | Nurse Practitioner - Acute Care | 5597 | TN |
N | 363LC0200X | Nurse Practitioner - Critical Care Medicine | 5597 | TN |
N | 363LF0000X | Nurse Practitioner - Family Medicine | 23279 | SC |
Y | 363LF0000X | Nurse Practitioner - Family Medicine | APN5597 | TN |
NPI | 1538125711 |
---|---|
Provider Name | Ms. Jane Ann Sullivan |
First Address | Brownsville, TN 38012-1610 |
Second Address | Brownsville, TN 38012-1610 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/04/2006 |
Last Update Date | 06/09/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
Q007039 | (05) | TN |
S86504 | (02) |