=====================================================
General NPI Number Information
=====================================================
NPI Number | 1811949415
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CARMEN ANA SIERRA M.D.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/16/2006
-----------------------------------------------------
Last Update Date | 05/11/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4741 OLD CANOE CREEK RD
-----------------------------------------------------
City | SAINT CLOUD
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34769-1400
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 321-805-4787
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7459 GATHERING LOOP
-----------------------------------------------------
City | REUNION
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34747-3128
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 773-425-3525
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | ME117196
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------