Provider Demographics
NPI:1174113039
Name:SUTHERLAND, LEILANI ANNE (FNP-BC)
Entity type:Individual
Prefix:
First Name:LEILANI
Middle Name:ANNE
Last Name:SUTHERLAND
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10441 HARLOW CIR UNIT 36
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92108-1871
Mailing Address - Country:US
Mailing Address - Phone:760-415-4310
Mailing Address - Fax:
Practice Address - Street 1:109 N EL CAMINO REAL # 9
Practice Address - Street 2:
Practice Address - City:ENCINITAS
Practice Address - State:CA
Practice Address - Zip Code:92024-2802
Practice Address - Country:US
Practice Address - Phone:619-293-7233
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-24
Last Update Date:2021-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95015849363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA95015849OtherNP NURSING LICENSE