Provider Demographics
NPI:1700546132
Name:BUCKLAND, IAN (FNP)
Entity Type:Individual
Prefix:
First Name:IAN
Middle Name:
Last Name:BUCKLAND
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1885 DIAMOND ST UNIT 2-321
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92109-3349
Mailing Address - Country:US
Mailing Address - Phone:951-239-2845
Mailing Address - Fax:
Practice Address - Street 1:151 CLAYDELLE AVE
Practice Address - Street 2:
Practice Address - City:EL CAJON
Practice Address - State:CA
Practice Address - Zip Code:92020-4505
Practice Address - Country:US
Practice Address - Phone:858-717-5029
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-27
Last Update Date:2021-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95018502363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily