Healthcare Provider Details

I. General information

NPI: 1902722721
Provider Name (Legal Business Name): MORGAN ELISE SUTHERLAND
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/25/2026
Last Update Date: 06/25/2026
Certification Date: 06/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9981 S HEALTHPARK DR
FORT MYERS FL
33908-3620
US

IV. Provider business mailing address

PO BOX 64
CAPTIVA FL
33924-0064
US

V. Phone/Fax

Practice location:
  • Phone: 410-207-3846
  • Fax:
Mailing address:
  • Phone: 410-207-3846
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: