Healthcare Provider Details

I. General information

NPI: 1124589106
Provider Name (Legal Business Name): SIERRA WEST APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/30/2019
Last Update Date: 08/31/2026
Certification Date: 08/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4364 FOREST HILL BLVD
WEST PALM BEACH FL
33406-5718
US

IV. Provider business mailing address

10299 SOUTHERN BLVD # 210132
ROYAL PALM BEACH FL
33411-4337
US

V. Phone/Fax

Practice location:
  • Phone: 561-248-7658
  • Fax:
Mailing address:
  • Phone: 561-248-7658
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN11047923
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: