Healthcare Provider Details

I. General information

NPI: 1386621019
Provider Name (Legal Business Name): JUDITH A. SIRON APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/23/2005
Last Update Date: 09/06/2022
Certification Date: 09/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 OAKFIELD DR.
BRANDON FL
33511
US

IV. Provider business mailing address

888 S. PARSONS AVE
BRANDON FL
33511
US

V. Phone/Fax

Practice location:
  • Phone: 813-654-2273
  • Fax: 813-413-8563
Mailing address:
  • Phone: 813-654-2273
  • Fax: 813-413-8563

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License NumberARNP9265982
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number0017136835
License Number StateVA
# 3
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License NumberAPRN9265982
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: