Individual
REBECCA JEANNE SULLIVAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CPNP
Contact information
Practice address
1401 W PULASKI ST, FORT WORTH, TX 76104-2717
(682) 885-8012
(682) 885-8014
Mailing address
PO BOX 99213, FORT WORTH, TX 76199-0213
(682) 885-1860
(682) 885-1396
Taxonomy
Speciality
Code
Description
License number
State
363LP0200X
Pediatric Nurse Practitioner
691809
TX
363LP2300X
Primary Care Nurse Practitioner
Primary
AP123430
TX
Other
Enumeration date
04/26/2013
Last updated
04/13/2021
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