Healthcare Provider Details

I. General information

NPI: 1902731839
Provider Name (Legal Business Name): CIERRA COLLEEN JURGENS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/13/2026
Last Update Date: 10/06/2026
Certification Date: 10/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12665 W SMOKEY DR STE 140
SURPRISE AZ
85378-3732
US

IV. Provider business mailing address

1701 HIGHWAY A1A STE 300
VERO BEACH FL
32963-2263
US

V. Phone/Fax

Practice location:
  • Phone: 623-219-4040
  • Fax:
Mailing address:
  • Phone: 561-320-0996
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: