Healthcare Provider Details

I. General information

NPI: 1508234105
Provider Name (Legal Business Name): LISA MARIE HIGGS FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/13/2015
Last Update Date: 09/13/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3724 EXECUTIVE CENTER DR STE 230
AUSTIN TX
78731-1646
US

IV. Provider business mailing address

1363 RED TOWN RD
ELGIN TX
78621-6542
US

V. Phone/Fax

Practice location:
  • Phone: 512-452-2100
  • Fax: 855-346-7410
Mailing address:
  • Phone: 512-285-9478
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP128410
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: