Healthcare Provider Details

I. General information

NPI: 1487305868
Provider Name (Legal Business Name): BROCK ANTHONY HIGGS NP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/17/2022
Last Update Date: 07/02/2026
Certification Date: 07/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4345 HARRISON BLVD STE 101
OGDEN UT
84403-3103
US

IV. Provider business mailing address

4345 HARRISON BLVD STE 101
OGDEN UT
84403-3103
US

V. Phone/Fax

Practice location:
  • Phone: 385-350-8500
  • Fax: 385-350-8555
Mailing address:
  • Phone: 385-350-8500
  • Fax: 385-350-8555

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number9629878-4405
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number9629878-4405
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: