Provider Demographics
NPI:1619139334
Name:SIERON, LESLIE A (ACNP)
Entity Type:Individual
Prefix:
First Name:LESLIE
Middle Name:A
Last Name:SIERON
Suffix:
Gender:F
Credentials:ACNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 160038
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33116-0038
Mailing Address - Country:US
Mailing Address - Phone:239-643-9977
Mailing Address - Fax:239-643-3424
Practice Address - Street 1:311 TAMIAMI TRL N
Practice Address - Street 2:SUITE 201
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34102-5885
Practice Address - Country:US
Practice Address - Phone:239-643-9977
Practice Address - Fax:239-643-3424
Is Sole Proprietor?:No
Enumeration Date:2008-06-25
Last Update Date:2009-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9267703363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLAZ865YMedicare PIN