Provider Demographics
NPI:1285238733
Name:ELIAS SIERRA, NANCY
Entity type:Individual
Prefix:
First Name:NANCY
Middle Name:
Last Name:ELIAS 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 1:5425 FRUITVILLE RD STE 16
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34232-6418
Mailing Address - Country:US
Mailing Address - Phone:941-343-9777
Mailing Address - Fax:
Practice Address - Street 1:2252 YANCY ST
Practice Address - Street 2:
Practice Address - City:NORTH PORT
Practice Address - State:FL
Practice Address - Zip Code:34291-5610
Practice Address - Country:US
Practice Address - Phone:786-365-5645
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-25
Last Update Date:2020-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL25816124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist