Provider Demographics
NPI:1487532370
Name:WIMER, SIERRA NICOLE (PA)
Entity type:Individual
Prefix:
First Name:SIERRA
Middle Name:NICOLE
Last Name:WIMER
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32 TREWIN CIR
Mailing Address - Street 2:
Mailing Address - City:ST AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32092-3377
Mailing Address - Country:US
Mailing Address - Phone:850-619-3245
Mailing Address - Fax:
Practice Address - Street 1:1497 E SKYLINE DR
Practice Address - Street 2:
Practice Address - City:OGDEN
Practice Address - State:UT
Practice Address - Zip Code:84405-4837
Practice Address - Country:US
Practice Address - Phone:850-619-3245
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-26
Last Update Date:2025-08-26
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant