Nancy L. Sullivan, NP

Primary specialty

Nurse PractitionerTaxonomy code 363L00000X

License

0024067080 Issued in VA

Practice address

12720 McManus Blvd
Suite 311
Newport News, VA 23602-4414

Phone

(757) 947-3170

Fax

(757) 947-3180

NPI assigned

Nov 4, 2008

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Interoperability endpoints

• FHIR API: https://fhir4.healow.com/fhir/r4/BGFHDD

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Tidewater Physicians Multispecialty Group PC

  • Ambulatory Surgical Clinic/Center
  • Williamsburg, VA
  • NPI 1316790512
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1225756800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1405296000000",
    "number": "1457504433",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7007 HARBOUR VIEW BLVD",
            "address_2": "SUITE 108",
            "city": "SUFFOLK",
            "state": "VA",
            "postal_code": "234352719",
            "telephone_number": "757-215-2784",
            "fax_number": "757-215-2728"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12720 MCMANUS BLVD",
            "address_2": "SUITE 311",
            "city": "NEWPORT NEWS",
            "state": "VA",
            "postal_code": "236024414",
            "telephone_number": "757-947-3170",
            "fax_number": "757-947-3180"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SULLIVAN",
        "first_name": "NANCY",
        "middle_name": "L.",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-11-04",
        "last_updated": "2014-07-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "VA",
            "license": "0024067080",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1457504433",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Stephen Su
• Suffolk United, Inc
• Harun Reza Sugito, MD
• Suh Dental PLLC
• John Michael Sullivan, PH.D.
• Summit Medical Diagnostics Inc
• Sherlyn Sumpter, RBT
• Sun World Homecare Agency Inc.
• Yankai Sun, M.D.
• Ik Sung, MD

• Nurse Practitioner in Newport News, VA
• Providers in Newport News, VA by specialty
• Nurse Practitioner in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 14, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.