Healthcare Provider Details

I. General information

NPI: 1790998482
Provider Name (Legal Business Name): MANDY HUGGINS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/08/2007
Last Update Date: 01/13/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2300 N COMMERCE PKWY SUITE 319
WESTON FL
33326-3254
US

IV. Provider business mailing address

2300 N COMMERCE PKWY SUITE 319
WESTON FL
33326-3254
US

V. Phone/Fax

Practice location:
  • Phone: 954-217-3111
  • Fax: 954-217-3240
Mailing address:
  • Phone: 954-217-3111
  • Fax: 954-217-3240

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081S0010X
TaxonomySports Medicine (Physical Medicine & Rehabilitation) Physician
License NumberME110615
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: