Provider Demographics
NPI:1164100376
Name:SIEROCUK, TAYLOR RENE' (AGACNP)
Entity Type:Individual
Prefix:
First Name:TAYLOR
Middle Name:RENE'
Last Name:SIEROCUK
Suffix:
Gender:F
Credentials:AGACNP
Other - Prefix:
Other - First Name:TAYLOR
Other - Middle Name:RENE'
Other - Last Name:SMEE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 776084
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60677-6084
Mailing Address - Country:US
Mailing Address - Phone:314-543-6979
Mailing Address - Fax:
Practice Address - Street 1:2708 S RIFE MEDICAL LN STE 220
Practice Address - Street 2:
Practice Address - City:ROGERS
Practice Address - State:AR
Practice Address - Zip Code:72758-1456
Practice Address - Country:US
Practice Address - Phone:479-338-4400
Practice Address - Fax:479-338-4445
Is Sole Proprietor?:No
Enumeration Date:2023-07-07
Last Update Date:2023-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARR093762163W00000X
AR12526976163WC0200X
AR225030363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No163W00000XNursing Service ProvidersRegistered Nurse
No163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine