Provider Demographics
NPI:1972272870
Name:HIGDON, HOLLY DARLENE (APRN)
Entity Type:Individual
Prefix:
First Name:HOLLY
Middle Name:DARLENE
Last Name:HIGDON
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12452 SE COUNTY ROAD 100A
Mailing Address - Street 2:
Mailing Address - City:STARKE
Mailing Address - State:FL
Mailing Address - Zip Code:32091-7052
Mailing Address - Country:US
Mailing Address - Phone:904-591-5836
Mailing Address - Fax:
Practice Address - Street 1:306 NE HIGHWAY 351
Practice Address - Street 2:
Practice Address - City:CROSS CITY
Practice Address - State:FL
Practice Address - Zip Code:32628-3105
Practice Address - Country:US
Practice Address - Phone:352-498-3372
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-13
Last Update Date:2021-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11013805363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care