Healthcare Provider Details

I. General information

NPI: 1689982308
Provider Name (Legal Business Name): JOAN V SUTHERLAND RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/15/2010
Last Update Date: 09/15/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2319 SE 58TH AVE
OCALA FL
34480-5840
US

IV. Provider business mailing address

14495 SE 80TH AVE
SUMMERFIELD FL
34491-3319
US

V. Phone/Fax

Practice location:
  • Phone: 352-620-0700
  • Fax: 352-620-2136
Mailing address:
  • Phone: 352-347-7232
  • Fax: 353-620-2136

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WE0003X
TaxonomyEmergency Registered Nurse
License NumberRN2245092
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code163WP0200X
TaxonomyPediatric Registered Nurse
License NumberRN2245092
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: