Provider Demographics
NPI:1376955856
Name:HIGGINBOTTOM, JACQUELINE CHRISTINE (ARNP)
Entity Type:Individual
Prefix:MRS
First Name:JACQUELINE
Middle Name:CHRISTINE
Last Name:HIGGINBOTTOM
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:MISS
Other - First Name:JACQUELINE
Other - Middle Name:CHRISTINE
Other - Last Name:ROSS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:PO BOX 917770
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32891-0001
Mailing Address - Country:US
Mailing Address - Phone:813-974-2201
Mailing Address - Fax:813-974-4325
Practice Address - Street 1:1 TAMPA GENERAL CIR
Practice Address - Street 2:PALLIATIVE CARE OFFICE
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33606-3571
Practice Address - Country:US
Practice Address - Phone:813-844-7000
Practice Address - Fax:813-844-1609
Is Sole Proprietor?:No
Enumeration Date:2014-06-02
Last Update Date:2021-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9308803163W00000X
DCRN1014133163W00000X
FLARNP9308803363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLC24FLOtherBLUE CROSS BLUE SHIELD