Healthcare Provider Details

I. General information

NPI: 1518524628
Provider Name (Legal Business Name): CONSTANCE K SIEKIERSKI MSN, APRN, FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2019
Last Update Date: 11/16/2022
Certification Date: 11/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5961 NW 173RD DR
HIALEAH FL
33015-5114
US

IV. Provider business mailing address

5961 NW 173RD DR
HIALEAH FL
33015-5114
US

V. Phone/Fax

Practice location:
  • Phone: 305-556-7500
  • Fax: 305-851-5708
Mailing address:
  • Phone: 305-556-7500
  • Fax: 305-851-5708

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN02059
License Number StateRI
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN11008584
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: