Healthcare Provider Details

I. General information

NPI: 1003140971
Provider Name (Legal Business Name): ANDREA S. HIGGINBOTHAM CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ANDREA S. PITTS CRNP

II. Dates (important events)

Enumeration Date: 09/25/2009
Last Update Date: 11/01/2024
Certification Date: 11/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13280 EVENING CREEK DR S STE 225
SAN DIEGO CA
92128-4664
US

IV. Provider business mailing address

13280 EVENING CREEK DR S STE 225
SAN DIEGO CA
92128-4664
US

V. Phone/Fax

Practice location:
  • Phone: 877-257-0637
  • Fax:
Mailing address:
  • Phone: 205-930-2456
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number1-105427
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: