Individual
JACK OSULLIVAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
2080 CHILD ST, JACKSONVILLE, FL 32214-5005
(902) 542-7300
Mailing address
2080 CHILD ST, JACKSONVILLE, FL 32214-5005
Taxonomy
Speciality
Code
Description
License number
State
171000000X
Military Health Care Provider
—
—
208D00000X
General Practice Physician
Primary
0102207445
VA
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
05/25/2021
Last updated
09/22/2023
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