Provider Demographics
NPI:1457583510
Name:HIGGINS, TRINA WINIFRED (RD)
Entity Type:Individual
Prefix:
First Name:TRINA
Middle Name:WINIFRED
Last Name:HIGGINS
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 BROOKWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95404-5258
Mailing Address - Country:US
Mailing Address - Phone:707-575-6043
Mailing Address - Fax:
Practice Address - Street 1:101 BROOKWOOD AVE
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95404-5258
Practice Address - Country:US
Practice Address - Phone:707-575-6043
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-08-21
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60142896133N00000X
86063474133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No133N00000XDietary & Nutritional Service ProvidersNutritionist