ANN NICOLE SULLIVAN (PA-C) – Physician Assistant, NPI 1073609707
Physician Assistant
Main info
Doctor Profile
Profile Insights
NPPES metrics only — not quality of care.
9,231 PHYSICIAN ASSISTANT in FL
Provider Addresses for ANN NICOLE SULLIVAN (PA-C)
PO BOX 746654
ATLANTA, GA 303746654
Phone: (904) 202-2092
Fax: (904) 376-4075
Type: Mailing
1301 PALM AVE
JACKSONVILLE, FL 322078432
Phone: (904) 202-7300
Fax: (904) 202-2754
Type: Location
308, Memorial Medical Parkway, Daytona Beach, Volusia County, Florida, 32117, United States
DAYTONA BEACH, FL 321175137
Phone: (386) 231-3600
Fax: (386) 231-3602
Type: Mailing
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
CMS reports 3 Open Payments records for all available years, with a total value of $307.
Total Amount is formed as General ($307) + Research ($0) + Ownership ($0) = $307.
Last reported payment date: 2024-05-16 • Largest payer in this snapshot: Davol Inc. ($144).
Total Amount
$307
General + Research + Ownership
Payments
3
Total payment records
General Amount
$307
General payments
Research Amount
$0
Research funding
Ownership Amount
$0
Ownership interests
Ownership Count
0
Ownership records
Last Payment Date
2024-05-16
Latest reported date
Top Companies
Largest payers in this snapshot
| Company | Amount |
|---|---|
| Davol Inc. | $144 |
| Zimmer Biomet Holdings, Inc. | $137 |
| Ethicon US, LLC | $26 |
Medicare Enrollment & Revalidation
Source: CMS public data · Not endorsed by CMS ·
Educational use only—not medical, billing, or legal advice.
PECOS enrollment status
Participating (accepts Medicare assignment)
Enrollment effective: 2020-03-13
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Due date not assigned yet
CMS is tracking 2 Medicare enrollment records; no due dates published yet.
Enrollment records
2
Earliest due date
Not assigned (TBD)
CMS data updated
2026-06-01
Revalidation progress
- Medicare enrolled
- On CMS revalidation list
- Due date assigned
- Revalidate in PECOS
CMS enrollment records
| Enrollment ID | Type | Specialty | State | Due date |
|---|---|---|---|---|
| I20130821000085 | I | Physician Assistant | CO | TBD |
| I20200313000845 | I | Physician Assistant | FL | TBD |
What to do next
- No action required while the due date shows TBD.
- Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
- Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.
Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS
Medicare Utilization (FFS)
Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·
Educational use only—not medical, billing, or legal advice.
No Medicare fee-for-service utilization data available for this provider in our database.
Insurance plans in this area (ZIP 30374)
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Group practice members
| Name | Specialty | State |
|---|---|---|
| - | FL | |
| Physician Assistant | FL | |
| - | FL | |
| General Surgery | OH | |
| Family Practice | FL | |
| - | FL | |
| Nurse Practitioner | FL | |
| - | FL | |
| - | FL | |
| Infectious Disease, Internal Medicine | FL |
Reviews
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