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General NPI Number Information
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NPI Number | 1992973960
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Entity Type | Organization
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Legal Business Name | KELLY HIGGINS
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Dates
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Enumeration Date | 02/13/2008
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Last Update Date | 01/06/2014
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Provider Practice Location Address
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Address Line | 1941 MOHICAN TRAIL
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City | MAITLAND
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State | FL
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Zip | 32751
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Country | US
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Telephone | 407-886-8164
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Fax | 407-886-0710
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Provider Business Mailing Address
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Address Line | 1941 MOHICAN TRL
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City | MAITLAND
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State | FL
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Zip | 32751-3729
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Country | US
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Telephone | 407-886-8164
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Fax | 407-886-0710
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Authorized Official
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Title or Position | PRESIDENT
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Name | KELLY HIGGINS
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Credential | ARNP
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Telephone | 407-886-8164
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | ARNP1930852
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License Number State | FL
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