Provider Demographics
NPI:1568280287
Name:SULLIVAN, BROOKE ANNE
Entity type:Individual
Prefix:
First Name:BROOKE
Middle Name:ANNE
Last Name:SULLIVAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7651 N OLDFATHER DR
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85741-1621
Mailing Address - Country:US
Mailing Address - Phone:520-616-3013
Mailing Address - Fax:520-579-4909
Practice Address - Street 1:7651 N OLDFATHER DR
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85741-1621
Practice Address - Country:US
Practice Address - Phone:520-616-3013
Practice Address - Fax:520-579-4909
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-01
Last Update Date:2024-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN196705163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool