Healthcare Provider Details

I. General information

NPI: 1801879374
Provider Name (Legal Business Name): JACQUELINE HIGGINS APRN, NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/29/2005
Last Update Date: 05/07/2021
Certification Date: 05/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 SAINT JOHNS BLVD
MAPLEWOOD MN
55109-1183
US

IV. Provider business mailing address

3821 HALIFAX AVE N
ROBBINSDALE MN
55422-2213
US

V. Phone/Fax

Practice location:
  • Phone: 651-232-5354
  • Fax:
Mailing address:
  • Phone: 763-843-3898
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License NumberR148755-4
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: