Provider Demographics
NPI:1730665654
Name:LOPEZ SIERRA, JACQUELINE VICTORIA
Entity Type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:VICTORIA
Last Name:LOPEZ SIERRA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:281 W 47TH ST
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33012-3957
Mailing Address - Country:US
Mailing Address - Phone:786-608-5805
Mailing Address - Fax:
Practice Address - Street 1:281 W 47TH ST
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33012-3957
Practice Address - Country:US
Practice Address - Phone:786-608-5805
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-13
Last Update Date:2023-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN941545363LP0808X
FL9415415363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health