Samantha Jane Sullivan, APRN

Primary specialty

Nurse PractitionerTaxonomy code 363L00000X

License

11033413 Issued in FL

Practice address

1600 SW Archer Rd
Gainesville, FL 32610-3001

Phone

(352) 273-9079

NPI assigned

Jun 21, 2024

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 names 1

• Samantha Jane Avalos Former name

Medicare fee-for-service enrollment

Enrolled in FL

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Nurse Practitioner

Education

Other, 2023

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Florida Clinical Practice Association IncGroup PAC ID 0345146254, 1,886 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Uf Health Shands Hospital Hospital, Gainesville, FL, CCN 100113

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

Networks

• Freedom Health HMO Network
• Optimum HealthCare HMO Network

Interoperability endpoints

• Direct secure messaging: ssullivan730019@direct.shands.ufl.edu

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.

• Florida Clinical Practice Association Inc

  • Surgery Physician
  • Gainesville, FL
  • NPI 1063463768
  Medicare reassignment Care Compare group NPD
• Florida Clinical Practice Association Inc

  • Durable Medical Equipment & Medical Supplies
  • Ocala, FL
  • NPI 1609529478
  NPD

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Shands Teaching Hospital and Clinics Inc

  • General Acute Care Hospital
  • Gainesville, FL
  • NPI 1083403661
  Care Compare affiliation
• Shands Teaching Hospital and Clinics Inc

  • General Acute Care Hospital
  • Gainesville, FL
  • NPI 1144019720
  Care Compare affiliation
• Shands Teaching Hospital and Clinics Inc

  • General Acute Care Hospital
  • Alachua, FL
  • NPI 1306717889
  Care Compare affiliation
• Shands Teaching Hospital and Clinics Inc

  • General Acute Care Hospital
  • Gainesville, FL
  • NPI 1396616876
  Care Compare affiliation
• Shands Teaching Hospital and Clinics Inc

  • General Acute Care Hospital
  • Newberry, FL
  • NPI 1477424943
  Care Compare affiliation
• Shands Teaching Hospital and Clinics Inc

  • General Acute Care Hospital
  • Gainesville, FL
  • NPI 1699874248
  Care Compare affiliation
• Shands Teaching Hospital and Clinics Inc

  • Radiology Clinic/Center
  • Ocala, FL
  • NPI 1942031232

  Hospital

  Care Compare affiliation
• Shands Teaching Hospital and Clinics Inc

  • General Acute Care Hospital
  • Ocala, FL
  • NPI 1992542369
  Care Compare affiliation

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

{
    "created_epoch": "1718928000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1733961600000",
    "number": "1508600859",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 100288",
            "city": "GAINESVILLE",
            "state": "FL",
            "postal_code": "326100277",
            "telephone_number": "352-273-9079"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1600 SW ARCHER RD",
            "city": "GAINESVILLE",
            "state": "FL",
            "postal_code": "326103001",
            "telephone_number": "352-273-9079"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SULLIVAN",
        "first_name": "SAMANTHA",
        "middle_name": "JANE",
        "credential": "APRN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-06-21",
        "last_updated": "2024-12-12",
        "certification_date": "2024-12-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "FL",
            "license": "11033413",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "SAMANTHA",
            "last_name": "AVALOS",
            "middle_name": "JANE",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Margaret Burns Sullivan, LCSW
• Matthew Daniel Sullivan, DMD
• Mellisa Sullivan
• Michael T Sullivan, OT
• Patricia Anne Sullivan, D.M.D.
• Sandra E Sullivan, MD
• Tara Flynn Sullivan, PHARMD
• Tonya Sullivan, APRN
• Amitabh Suman, MD
• Jill Michelle Sumfest, M.D.

• Nurse Practitioner in Gainesville, FL
• Providers in Gainesville, FL by specialty
• Nurse Practitioner in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 12, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.