Provider Demographics
NPI:1730143413
Name:HIGHTOWER, VERNORA D (MD)
Entity Type:Individual
Prefix:
First Name:VERNORA
Middle Name:D
Last Name:HIGHTOWER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8117 POINT MEADOWS WAY
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32256-9694
Mailing Address - Country:US
Mailing Address - Phone:904-519-6555
Mailing Address - Fax:904-519-6550
Practice Address - Street 1:8117 POINT MEADOWS WAY
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32256-9694
Practice Address - Country:US
Practice Address - Phone:904-519-6555
Practice Address - Fax:904-519-6550
Is Sole Proprietor?:No
Enumeration Date:2006-04-12
Last Update Date:2016-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME125743208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL016278500Medicaid
FL016278500Medicaid