Provider Demographics
NPI:1396918082
Name:SULLIVAN-JAWITZ, ELIZABETH ANN (ARNP)
Entity type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:ANN
Last Name:SULLIVAN-JAWITZ
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 1:10979 MAINSAIL DR.
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33026-4720
Mailing Address - Country:US
Mailing Address - Phone:954-447-7020
Mailing Address - Fax:
Practice Address - Street 1:915 MIDDLE RIVER DR STE 114
Practice Address - Street 2:
Practice Address - City:FT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33304-3586
Practice Address - Country:US
Practice Address - Phone:954-368-0888
Practice Address - Fax:954-212-2227
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-02
Last Update Date:2016-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP3017212363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL26-1734481OtherEIN