Provider Demographics
NPI:1619156973
Name:HIGGS, TINA (NP)
Entity Type:Individual
Prefix:MRS
First Name:TINA
Middle Name:
Last Name:HIGGS
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 1:300 WHITE SPRUCE BOULEVARD
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14623
Mailing Address - Country:US
Mailing Address - Phone:585-424-6770
Mailing Address - Fax:585-424-6776
Practice Address - Street 1:300 WHITE SPRUCE BOULEVARD
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14623
Practice Address - Country:US
Practice Address - Phone:585-424-6770
Practice Address - Fax:585-424-6776
Is Sole Proprietor?:No
Enumeration Date:2007-11-02
Last Update Date:2010-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024167298363L00000X
NYF336415-1363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner