Basic Information
| Provider Information | |||||||||
| NPI: | 1346523156 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HIGGINS | ||||||||
| FirstName: | TRACY | ||||||||
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| Credential: | NP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5620 BROOK RD | ||||||||
| Address2: | |||||||||
| City: | RICHMOND | ||||||||
| State: | VA | ||||||||
| PostalCode: | 232272273 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8044323503 | ||||||||
| FaxNumber: | 8042625113 | ||||||||
| Practice Location | |||||||||
| Address1: | 5620 BROOK RD | ||||||||
| Address2: | |||||||||
| City: | RICHMOND | ||||||||
| State: | VA | ||||||||
| PostalCode: | 232272273 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8044323503 | ||||||||
| FaxNumber: | 8042625113 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/28/2011 | ||||||||
| LastUpdateDate: | 08/29/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | 0001217185 | VA | N | Nursing Service Providers | Registered Nurse | 363L00000X | 0024169640 | VA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | 364S00000X | 0015000926 | VA | N | Physician Assistants & Advanced Practice Nursing Providers | Clinical Nurse Specialist |
No ID Information.