Provider Demographics
NPI:1326505348
Name:TANGUAY HIGGINS, MARYANNE (MONTRICE/DOULA IBCLC)
Entity Type:Individual
Prefix:
First Name:MARYANNE
Middle Name:
Last Name:TANGUAY HIGGINS
Suffix:
Gender:F
Credentials:MONTRICE/DOULA IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:708 PORSCHE AVE
Mailing Address - Street 2:
Mailing Address - City:SEBRING
Mailing Address - State:FL
Mailing Address - Zip Code:33872-2879
Mailing Address - Country:US
Mailing Address - Phone:863-382-9789
Mailing Address - Fax:
Practice Address - Street 1:708 PORSCHE AVE
Practice Address - Street 2:
Practice Address - City:SEBRING
Practice Address - State:FL
Practice Address - Zip Code:33872-2879
Practice Address - Country:US
Practice Address - Phone:863-382-9789
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-26
Last Update Date:2021-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL102920500Medicaid