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
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3952 PLATEAU PL
Mailing Address - Street 2:
Mailing Address - City:CARLSBAD
Mailing Address - State:CA
Mailing Address - Zip Code:92010-7082
Mailing Address - Country:US
Mailing Address - Phone:973-626-7551
Mailing Address - Fax:
Practice Address - Street 1:27412 ENTERPRISE CIR W STE 102
Practice Address - Street 2:
Practice Address - City:TEMECULA
Practice Address - State:CA
Practice Address - Zip Code:92590-4801
Practice Address - Country:US
Practice Address - Phone:951-694-6367
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-04
Last Update Date:2018-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP95007904363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily