Provider Demographics
NPI:1811949415
Name:SIERRA, CARMEN ANA (MD)
Entity type:Individual
Prefix:
First Name:CARMEN
Middle Name:ANA
Last Name:SIERRA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7459 GATHERING LOOP
Mailing Address - Street 2:
Mailing Address - City:REUNION
Mailing Address - State:FL
Mailing Address - Zip Code:34747-3128
Mailing Address - Country:US
Mailing Address - Phone:773-425-3525
Mailing Address - Fax:
Practice Address - Street 1:4741 OLD CANOE CREEK RD
Practice Address - Street 2:
Practice Address - City:SAINT CLOUD
Practice Address - State:FL
Practice Address - Zip Code:34769-1400
Practice Address - Country:US
Practice Address - Phone:321-805-4787
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-16
Last Update Date:2015-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME117196207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL014499000Medicaid
FL014499000Medicaid
ILG40931Medicare UPIN