Individual
LISA A SULLIVAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
C.R.N.A.
Contact information
Practice address
8380 RIVERWALK PARK BLVD STE 220, FORT MYERS, FL 33919-8758
(239) 215-4104
Mailing address
4261 TREE TOPS DR, PORT CHARLOTTE, FL 33953-5919
(603) 591-5739
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
033956-23-11
NH
367500000X
Certified Registered Nurse Anesthetist
Primary
033956-23
NH
Other
Enumeration date
01/05/2006
Last updated
10/29/2022
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