Jacquelyn Marie Sullivan, NURSE PRACTITIONER

Primary specialty

Acute Care Nurse PractitionerTaxonomy code 363LA2100X

License

08877 Issued in OH

Practice address

2301 Erwin Rd
Department of Surgery
Durham, NC 27705-4699

Phone

(919) 864-8111

NPI assigned

Aug 2, 2005

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

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

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.

• Care Group LLC

  • Cardiovascular Disease Physician
  • Indianapolis, IN
  • NPI 1649220195
  NPD (past)
• Jewish Hospital of Cincinnati, Inc.

  • General Acute Care Hospital
  • Cincinnati, OH
  • NPI 1972544856
  NPD (past)

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

{
    "created_epoch": "1122940800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1492300800000",
    "number": "1912908740",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2301 ERWIN RD",
            "address_2": "DEPARTMENT OF SURGERY",
            "city": "DURHAM",
            "state": "NC",
            "postal_code": "277054699",
            "telephone_number": "919-864-8111"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2301 ERWIN RD",
            "address_2": "DEPARTMENT OF SURGERY",
            "city": "DURHAM",
            "state": "NC",
            "postal_code": "277054699",
            "telephone_number": "919-864-8111"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SULLIVAN",
        "first_name": "JACQUELYN",
        "middle_name": "MARIE",
        "credential": "NURSE PRACTITIONER",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-08-02",
        "last_updated": "2017-04-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2100X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Acute Care",
            "state": "OH",
            "license": "08877",
            "primary": true
        },
        {
            "code": "363LG0600X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Gerontology",
            "state": "OH",
            "license": "08877",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200191600",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Rebecca Sullenger
• Brian Sullivan, MD, MHS
• Colten Briar Sullivan, DPT
• Daniel Carl Sullivan, M.D.
• Elizabeth Sullivan, MD
• Jasmine Danielle Sullivan, DNP, FNP-BC
• Jennifer Anne Sullivan, MS, CGC
• John Stevens Sullivan II, LMFTA
• Keith Sullivan, M.D.
• Kelly Sullivan

• Acute Care Nurse Practitioner in Durham, NC
• Providers in Durham, NC by specialty
• Acute Care Nurse Practitioner in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 16, 2017; 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.