Provider Demographics
NPI:1326513441
Name:NIBBELINK AHEARN, SANDRA LYNN (NP)
Entity type:Individual
Prefix:
First Name:SANDRA
Middle Name:LYNN
Last Name:NIBBELINK AHEARN
Suffix:
Gender:F
Credentials:NP
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Mailing Address - Street 1:4225 EXECUTIVE SQ STE 450
Mailing Address - Street 2:
Mailing Address - City:LA JOLLA
Mailing Address - State:CA
Mailing Address - Zip Code:92037-8411
Mailing Address - Country:US
Mailing Address - Phone:858-810-8000
Mailing Address - Fax:858-268-1911
Practice Address - Street 1:3300 VISTA WAY STE B
Practice Address - Street 2:
Practice Address - City:OCEANSIDE
Practice Address - State:CA
Practice Address - Zip Code:92056-3633
Practice Address - Country:US
Practice Address - Phone:760-967-9900
Practice Address - Fax:760-967-6769
Is Sole Proprietor?:No
Enumeration Date:2018-10-04
Last Update Date:2024-09-24
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CANP95007904363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily