Provider Demographics
NPI:1144993882
Name:SUTHERLAND, NINA SHANNON (NP)
Entity type:Individual
Prefix:
First Name:NINA
Middle Name:SHANNON
Last Name:SUTHERLAND
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:NINA
Other - Middle Name:SHANNON
Other - Last Name:JORDAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1750 WALKING HORSE TRL
Mailing Address - Street 2:
Mailing Address - City:CUMMING
Mailing Address - State:GA
Mailing Address - Zip Code:30041-8389
Mailing Address - Country:US
Mailing Address - Phone:678-283-8452
Mailing Address - Fax:
Practice Address - Street 1:3970 DEPUTY BILL CANTRELL MEM
Practice Address - Street 2:
Practice Address - City:CUMMING
Practice Address - State:GA
Practice Address - Zip Code:30040-3069
Practice Address - Country:US
Practice Address - Phone:678-513-2273
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-28
Last Update Date:2021-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN145366363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner