Healthcare Provider Details

I. General information

NPI: 1215002738
Provider Name (Legal Business Name): ALICIA A HIGGINS PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/21/2006
Last Update Date: 02/19/2021
Certification Date: 02/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3640 MAIN ST SUITE 302
SPRINGFIELD MA
01107-1145
US

IV. Provider business mailing address

59 GIANNA DR
MANCHESTER CT
06042-1972
US

V. Phone/Fax

Practice location:
  • Phone: 413-732-4242
  • Fax:
Mailing address:
  • Phone: 413-695-1887
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number002394
License Number StateCT
# 2
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License NumberPA2188
License Number StateMA
# 3
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number2188
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: