Basic Information
| Provider Information | |||||||||
| NPI: | 1437471778 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SULLIVAN | ||||||||
| FirstName: | NANCY | ||||||||
| MiddleName: | J | ||||||||
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| Credential: | FNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7885 N ORACLE RD | ||||||||
| Address2: | |||||||||
| City: | ORO VALLEY | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 857046348 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5202325280 | ||||||||
| FaxNumber: | 5202325299 | ||||||||
| Practice Location | |||||||||
| Address1: | 1323 W PRINCE RD | ||||||||
| Address2: | |||||||||
| City: | TUCSON | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 857053114 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5208870800 | ||||||||
| FaxNumber: | 5208871393 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/26/2010 | ||||||||
| LastUpdateDate: | 03/11/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | RN135312 | AZ | N | Nursing Service Providers | Registered Nurse | 363LF0000X | AP3540 | AZ | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
ID Information
| ID | Type | State | Issuer | Description | 499768 | 05 | AZ | MEDICAID |