Individual
MARY JOSEPHINE SUTHERLAND
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
P.A.-C
Contact information
Practice address
3189 US HIGHWAY 17, FLEMING ISLAND, FL 32003-7109
(904) 621-0247
(904) 339-9945
Mailing address
3189 HIGHWAY 17, GREEN COVE SPRINGS, FL 32043-9371
(904) 621-0247
(904) 339-9945
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
PA2225
FL
363AM0700X
Medical Physician Assistant
Primary
PA2225
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
291115900
—
FL
Enumeration date
07/20/2006
Last updated
09/21/2022
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