Provider Demographics
NPI:1437882511
Name:HIGGINS, TRACEY RENEE (FNP-C)
Entity Type:Individual
Prefix:
First Name:TRACEY
Middle Name:RENEE
Last Name:HIGGINS
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14406A FAIRVIEW RD
Mailing Address - Street 2:
Mailing Address - City:CLEAR SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:21722-1242
Mailing Address - Country:US
Mailing Address - Phone:301-302-3573
Mailing Address - Fax:
Practice Address - Street 1:24 N WALNUT ST STE 100
Practice Address - Street 2:
Practice Address - City:HAGERSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21740-4741
Practice Address - Country:US
Practice Address - Phone:240-452-3400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-06
Last Update Date:2022-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR153914363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily