Healthcare Provider Details

I. General information

NPI: 1003365461
Provider Name (Legal Business Name): JENNIFER SIERRA ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/27/2016
Last Update Date: 06/26/2026
Certification Date: 06/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13421 S SHORE BLVD STE 101
WELLINGTON FL
33414
US

IV. Provider business mailing address

367 S. GULPH RD ATTN: IPM CREDENTIALING
KING OF PRUSSIA PA
19406-3121
US

V. Phone/Fax

Practice location:
  • Phone: 561-440-1616
  • Fax: 561-440-2030
Mailing address:
  • Phone: 561-440-1616
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN9311565
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPRN9311565
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: