Provider Demographics
NPI:1255121174
Name:SIERRA, JAQUELINE (PA-C)
Entity type:Individual
Prefix:
First Name:JAQUELINE
Middle Name:
Last Name:SIERRA
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3025 SHRINE RD STE 190
Mailing Address - Street 2:
Mailing Address - City:BRUNSWICK
Mailing Address - State:GA
Mailing Address - Zip Code:31520-4788
Mailing Address - Country:US
Mailing Address - Phone:912-466-7250
Mailing Address - Fax:912-466-7253
Practice Address - Street 1:3025 SHRINE RD STE 190
Practice Address - Street 2:
Practice Address - City:BRUNSWICK
Practice Address - State:GA
Practice Address - Zip Code:31520-4788
Practice Address - Country:US
Practice Address - Phone:912-466-7250
Practice Address - Fax:912-466-7253
Is Sole Proprietor?:No
Enumeration Date:2025-05-12
Last Update Date:2025-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA13072207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology