Healthcare Provider Details

I. General information

NPI: 1497769657
Provider Name (Legal Business Name): KELLY HIGGINS ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/27/2006
Last Update Date: 05/23/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

89 W COPELAND DR
ORLANDO FL
32806-2028
US

IV. Provider business mailing address

1941 MOHICAN TRAIL
MAITLAND FL
32751
US

V. Phone/Fax

Practice location:
  • Phone: 407-841-5281
  • Fax: 407-648-9879
Mailing address:
  • Phone: 407-325-6712
  • Fax: 855-708-2323

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number1930852
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: