Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | APRN9311565 | FL |
NPI | 1003365461 |
---|---|
Provider Name | Jennifer Sierra |
First Address | King Of Prussia, PA 19406-3121 |
Second Address | Wellington, FL 33414 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/09/2016 |
Last Update Date | 06/02/2019 |