Individual
TONYA JORDAN SULLIVAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NURSE PRACTITIONER
Contact information
Practice address
125 DAYS INN DR, MOORESVILLE, NC 28117-6323
(704) 660-9111
Mailing address
PO BOX 1845, STATESVILLE, NC 28687-1845
(704) 873-4277
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
5013206
NC
Other
Enumeration date
06/04/2020
Last updated
08/10/2023
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