Provider Demographics
NPI:1750887238
Name:SULLIVAN, BRITTANY (DO)
Entity type:Individual
Prefix:
First Name:BRITTANY
Middle Name:
Last Name:SULLIVAN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:BRITTANY
Other - Middle Name:SIOBHAN
Other - Last Name:SULLIVAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:100 S ASHLEY DR
Mailing Address - Street 2:STE 600
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33602-5300
Mailing Address - Country:US
Mailing Address - Phone:910-568-9297
Mailing Address - Fax:813-701-9323
Practice Address - Street 1:100 S ASHLEY DR STE 600
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33602-5300
Practice Address - Country:US
Practice Address - Phone:813-386-8300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-03
Last Update Date:2024-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC91289207R00000X
FL17723207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL17723OtherMEDICAL LICENSE