Healthcare Provider Details

I. General information

NPI: 1114929643
Provider Name (Legal Business Name): PULMONARY PRACTICE ASSOCIATES MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/15/2005
Last Update Date: 06/10/2025
Certification Date: 06/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1075 TOWN CENTER DR
ORANGE CITY FL
32763-8360
US

IV. Provider business mailing address

1075 TOWN CENTER DR
ORANGE CITY FL
32763-8360
US

V. Phone/Fax

Practice location:
  • Phone: 386-917-0333
  • Fax:
Mailing address:
  • Phone: 386-917-0333
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RS0012X
TaxonomySleep Medicine (Internal Medicine) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number
License Number State

VIII. Authorized Official

Name: NATASHA SIERRA
Title or Position: PRACTICE MANAGER
Credential:
Phone: 386-917-0333