Healthcare Provider Details

I. General information

NPI: 1982936373
Provider Name (Legal Business Name): TARA C HIGGINS RPH, CDOE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/10/2010
Last Update Date: 02/10/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

290 FORGE RD
NORTH KINGSTOWN RI
02852-1010
US

IV. Provider business mailing address

290 FORGE RD
NORTH KINGSTOWN RI
02852-1010
US

V. Phone/Fax

Practice location:
  • Phone: 401-885-2933
  • Fax:
Mailing address:
  • Phone: 401-885-2933
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRPH03847
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: