Provider Demographics
NPI:1912619297
Name:MAGUIRE, SIERRA NICOLE (PA-C)
Entity Type:Individual
Prefix:
First Name:SIERRA
Middle Name:NICOLE
Last Name:MAGUIRE
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:PO BOX 13834
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32317-3834
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:616 STATE ROAD 13 STE 8
Practice Address - Street 2:
Practice Address - City:ST JOHNS
Practice Address - State:FL
Practice Address - Zip Code:32259-3868
Practice Address - Country:US
Practice Address - Phone:904-512-1899
Practice Address - Fax:904-770-7592
Is Sole Proprietor?:No
Enumeration Date:2022-12-19
Last Update Date:2023-01-18
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant