Provider Demographics
NPI:1427181015
Name:HIGGINS, ELAINA (NP)
Entity Type:Individual
Prefix:
First Name:ELAINA
Middle Name:
Last Name:HIGGINS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1820 HAYNES ST
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37043-4547
Mailing Address - Country:US
Mailing Address - Phone:931-245-1500
Mailing Address - Fax:931-245-1500
Practice Address - Street 1:1820 HAYNES ST
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37043-4547
Practice Address - Country:US
Practice Address - Phone:931-245-1500
Practice Address - Fax:931-245-1544
Is Sole Proprietor?:No
Enumeration Date:2007-03-13
Last Update Date:2014-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY5027P363L00000X
TN12265363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ001338Medicaid
TN10350I7229Medicare PIN