Provider Demographics
NPI:1457585325
Name:HIGGINS, MARY W
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:W
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 1:5340 SE DELL ST
Mailing Address - Street 2:
Mailing Address - City:STUART
Mailing Address - State:FL
Mailing Address - Zip Code:34997-8048
Mailing Address - Country:US
Mailing Address - Phone:561-420-2925
Mailing Address - Fax:772-219-3809
Practice Address - Street 1:5340 SE DELL ST
Practice Address - Street 2:
Practice Address - City:STUART
Practice Address - State:FL
Practice Address - Zip Code:34997-8048
Practice Address - Country:US
Practice Address - Phone:561-420-2925
Practice Address - Fax:772-219-3809
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-07
Last Update Date:2009-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL693495101Medicaid
FL693495196Medicaid