Healthcare Provider Details

I. General information

NPI: 1720933294
Provider Name (Legal Business Name): ASHLEY HIGGINBOTHAM APRN, CPNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/02/2026
Last Update Date: 03/02/2026
Certification Date: 03/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

170 PINE AVE N
OLDSMAR FL
34677-4629
US

IV. Provider business mailing address

170 PINE AVE N
OLDSMAR FL
34677-4629
US

V. Phone/Fax

Practice location:
  • Phone: 813-553-4448
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number11045705
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: