Provider Demographics
NPI:1265083752
Name:HERBERT, SIERRA N (PA-C)
Entity type:Individual
Prefix:
First Name:SIERRA
Middle Name:N
Last Name:HERBERT
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 1:5841 NE 21ST DR
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33308-2511
Mailing Address - Country:US
Mailing Address - Phone:954-804-6831
Mailing Address - Fax:
Practice Address - Street 1:5597 N DIXIE HWY
Practice Address - Street 2:
Practice Address - City:OAKLAND PARK
Practice Address - State:FL
Practice Address - Zip Code:33334-3406
Practice Address - Country:US
Practice Address - Phone:954-958-4800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-25
Last Update Date:2020-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9112383363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical