Provider Demographics
NPI:1376034504
Name:HIGGINS, AMANDA LEA (CRNP)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:LEA
Last Name:HIGGINS
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1680 MONTGOMERY HWY
Mailing Address - Street 2:
Mailing Address - City:VESTAVIA HILLS
Mailing Address - State:AL
Mailing Address - Zip Code:35216-4906
Mailing Address - Country:US
Mailing Address - Phone:205-979-0888
Mailing Address - Fax:
Practice Address - Street 1:1680 MONTGOMERY HWY
Practice Address - Street 2:
Practice Address - City:HOOVER
Practice Address - State:AL
Practice Address - Zip Code:35216
Practice Address - Country:US
Practice Address - Phone:205-979-0888
Practice Address - Fax:205-979-4110
Is Sole Proprietor?:No
Enumeration Date:2018-05-23
Last Update Date:2018-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-111031363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily