Provider Demographics
NPI:1396142014
Name:SULLIVAN, ERIN (NP)
Entity type:Individual
Prefix:MS
First Name:ERIN
Middle Name:
Last Name:SULLIVAN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 211
Mailing Address - Street 2:
Mailing Address - City:AROMAS
Mailing Address - State:CA
Mailing Address - Zip Code:95004-0211
Mailing Address - Country:US
Mailing Address - Phone:831-277-6168
Mailing Address - Fax:
Practice Address - Street 1:2930 2ND AVE STE 120
Practice Address - Street 2:
Practice Address - City:MARINA
Practice Address - State:CA
Practice Address - Zip Code:93933-6244
Practice Address - Country:US
Practice Address - Phone:831-622-6935
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-24
Last Update Date:2024-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95001703363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily