Provider Demographics
NPI:1063760056
Name:SUTHERLAND, CAROLINE JANE (FNP-C)
Entity type:Individual
Prefix:MRS
First Name:CAROLINE
Middle Name:JANE
Last Name:SUTHERLAND
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2717 SUMMERHILL RD
Mailing Address - Street 2:
Mailing Address - City:TEXARKANA
Mailing Address - State:TX
Mailing Address - Zip Code:75503-3957
Mailing Address - Country:US
Mailing Address - Phone:903-792-3773
Mailing Address - Fax:903-792-1291
Practice Address - Street 1:2717 SUMMERHILL RD
Practice Address - Street 2:
Practice Address - City:TEXARKANA
Practice Address - State:TX
Practice Address - Zip Code:75503
Practice Address - Country:US
Practice Address - Phone:903-792-3773
Practice Address - Fax:903-792-1291
Is Sole Proprietor?:No
Enumeration Date:2012-08-22
Last Update Date:2018-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP122066363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily