Healthcare Provider Details

I. General information

NPI: 1376403147
Provider Name (Legal Business Name): HIGHTIDE HEALTHCARE PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/14/2025
Last Update Date: 01/06/2026
Certification Date: 01/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5200 N CROATAN HWY STE 9
KITTY HAWK NC
27949-3990
US

IV. Provider business mailing address

PO BOX 1048
KITTY HAWK NC
27949-1048
US

V. Phone/Fax

Practice location:
  • Phone: 757-515-8071
  • Fax:
Mailing address:
  • Phone: 757-515-8071
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: LEAH H WOOLRIDGE
Title or Position: OWNER/NP
Credential: FNP-BC
Phone: 757-515-8071