Provider Demographics
NPI:1922726819
Name:HIGGINS, TRACY
Entity Type:Individual
Prefix:
First Name:TRACY
Middle Name:
Last Name:HIGGINS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31292 ALPINE MEADOWS RD
Mailing Address - Street 2:
Mailing Address - City:SHINGLETOWN
Mailing Address - State:CA
Mailing Address - Zip Code:96088-9462
Mailing Address - Country:US
Mailing Address - Phone:530-474-3390
Mailing Address - Fax:
Practice Address - Street 1:31292 ALPINE MEADOWS RD
Practice Address - Street 2:
Practice Address - City:SHINGLETOWN
Practice Address - State:CA
Practice Address - Zip Code:96088-9462
Practice Address - Country:US
Practice Address - Phone:530-474-3390
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-17
Last Update Date:2022-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95022213363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily