Individual
KAYLA SULLIVAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1215 PAGANO CT, PORT ORANGE, FL 32129-4030
(386) 316-3760
Mailing address
1215 PAGANO CT, PORT ORANGE, FL 32129-4030
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
11043953
FL
Other
Enumeration date
12/01/2025
Last updated
12/01/2025
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