Active NPI
Taylor Anne Sullivan, M.S., ATC
- Athletic Trainer
- Deland, FL
National Provider Identifier
1912368192
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Athletic Trainer
- License
- AL 4291
- Practice address
- 421 N Woodland Blvd
Unit 8284
Deland, FL 32723-8300 - Phone
- (386) 822-7152
- Fax
- (386) 822-8143
- NPI assigned
- Mar 15, 2016
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Athletic Trainer | 2255A2300X | AL 4291 | FL | Primary |
Addresses
Primary practice location
421 N Woodland Blvd
Unit 8284
Deland, FL 32723-8300
Mailing address
421 N Woodland Blvd
Unit 8284
Deland, FL 32723-8300
Phone (386) 822-7152
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| AL 4291 | Other | FL | FLORIDA ATHLETIC TRAINING ASSOCIATION LINCENSURE |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| AL 4291 | FL | MD | Athletic Trainer |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1458000000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1458000000000",
"number": "1912368192",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "421 N WOODLAND BLVD",
"address_2": "UNIT 8284",
"city": "DELAND",
"state": "FL",
"postal_code": "327238300",
"telephone_number": "386-822-7152",
"fax_number": "386-822-8143"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "421 N WOODLAND BLVD",
"address_2": "UNIT 8284",
"city": "DELAND",
"state": "FL",
"postal_code": "327238300",
"telephone_number": "386-822-7152",
"fax_number": "386-822-8143"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SULLIVAN",
"first_name": "TAYLOR",
"middle_name": "ANNE",
"credential": "M.S., ATC",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2016-03-15",
"last_updated": "2016-03-15",
"status": "A"
},
"taxonomies": [
{
"code": "2255A2300X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": "FL",
"license": "AL 4291",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "FLORIDA ATHLETIC TRAINING ASSOCIATION LINCENSURE",
"identifier": "AL 4291",
"state": "FL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Deland, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 15, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.