MEDICARE: BRIAN HIGUERA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	390200000X	Student in an Organized Health Care Education/Training Program
2	363A00000X	Physician Assistant

General Provider Information

NPI Number	:	1962117895
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRIAN HIGUERA

Provider Business Mailing Address
First Line	:	4612 CONCORDIA LN
Second Line	:
City	:	BOYNTON BEACH
State	:	FL
Zip	:	33436-1996
Country	:	US
Telephone Number	:	561-252-6226
Fax Number	:

Provider Business Practice Location Address
First Line	:	5920 METROPOLIS WAY STE 101
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32811-2706
Country	:	US
Telephone Number	:	844-665-4827
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/16/2023
Last Update Date	:	11/11/2024

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Directions to “ BRIAN HIGUERA ” Practice Location

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