Healthcare Provider Details

I. General information

NPI: 1902731839
Provider Name (Legal Business Name): CIERRA COLLEEN JURGENS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/13/2026
Last Update Date: 06/13/2026
Certification Date: 06/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

432 YELLOW BELL RUN
DRIPPING SPRINGS TX
78620-2686
US

IV. Provider business mailing address

432 YELLOW BELL RUN
DRIPPING SPRINGS TX
78620-2686
US

V. Phone/Fax

Practice location:
  • Phone: 301-676-6190
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: