Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Ann Nicole Sullivan, PA-C

Individual provider Surgical Physician Assistant · NPI 1073609707

Ann Nicole Sullivan, PA-C is a Physician Assistant in Jacksonville, Florida. Qualified in 2010, 16 years ago. Practices with Memorial Family Practice Associates, LLC, a 50-clinician group and accepts Medicare assignment. Licensed in Colorado, Florida and Texas.

Years since qualifying
16
Licensed in
CO, FL, TX
In the registry since
2006
Specialties on file
5
What do these letters mean?
PA-C — Physician Assistant, Certified
A physician assistant who holds current national certification.

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Practice location Address checks out

1301 Palm Ave
Jacksonville, FL 32207-8432
Phone: (904) 202-7300
Fax: (904) 202-2754
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Physician Assistant (primary) Taxonomy 363A00000X · Licence PA9113026 (FL)
Surgical Physician Assistant Taxonomy 363AS0400X · Licence PA3713 (CO)
Surgical Physician Assistant Taxonomy 363AS0400X · Licence PA9113026 (FL)
Physician Assistant Taxonomy 363A00000X · Licence PA03286 (TX)
Medical Physician Assistant Taxonomy 363AM0700X · Licence PA3713 (CO)

Record details

NPI number1073609707
Entity typeIndividual (Type 1)
GenderFemale
Credentials PA-C
Sole proprietorNo
NPI enumeratedOctober 4, 2006
Last updated in NPPESJuly 8, 2025
Certification dateJuly 8, 2025

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyPHYSICIAN ASSISTANT
Medical schoolOTHER
Graduated 2010 (16 years in practice)
Group practice Memorial Family Practice Associates, Llc — 50 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations2 on file with Medicare

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