Individual
MISS JILLIAN ANN SULLIVAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APRN
Contact information
Practice address
263 FARMINGTON AVE, INTERNAL MEDICINE, FARMINGTON, CT 06030-2212
(860) 679-4477
(860) 679-4474
Mailing address
236 SHAGBARK DR, BRISTOL, CT 06010-3220
(860) 940-8132
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
Primary
005128
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1639423734
—
CT
Enumeration date
10/29/2012
Last updated
02/05/2013
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