Provider Demographics
NPI:1124451547
Name:SULLIVAN, JACQUELINE FLORENTINO (ARNP)
Entity type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:FLORENTINO
Last Name: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 1:920 W INDIANTOWN RD
Mailing Address - Street 2:SUITE 107
Mailing Address - City:JUPITER
Mailing Address - State:FL
Mailing Address - Zip Code:33458-6847
Mailing Address - Country:US
Mailing Address - Phone:561-747-7707
Mailing Address - Fax:
Practice Address - Street 1:920 W INDIANTOWN RD
Practice Address - Street 2:SUITE 107
Practice Address - City:JUPITER
Practice Address - State:FL
Practice Address - Zip Code:33458-6847
Practice Address - Country:US
Practice Address - Phone:561-747-7707
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-21
Last Update Date:2013-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9264181111NI0900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NI0900XChiropractic ProvidersChiropractorInternistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL9264181OtherARNP