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General NPI Number Information
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NPI Number | 1962117895
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Entity Type | Individual
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Provider Name | BRIAN HIGUERA
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Gender | Male
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Dates
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Enumeration Date | 01/16/2023
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Last Update Date | 11/11/2024
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Provider Practice Location Address
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Address Line | 5920 METROPOLIS WAY STE 101
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City | ORLANDO
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State | FL
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Zip | 32811-2706
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Country | US
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Telephone | 844-665-4827
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Fax |
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Provider Business Mailing Address
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Address Line | 4612 CONCORDIA LN
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City | BOYNTON BEACH
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State | FL
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Zip | 33436-1996
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Country | US
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Telephone | 561-252-6226
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number |
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License Number State |
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