Provider Demographics
NPI:1649435611
Name:HIGHTMAN, PHILIP C (AP)
Entity type:Individual
Prefix:
First Name:PHILIP
Middle Name:C
Last Name:HIGHTMAN
Suffix:
Gender:M
Credentials:AP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4605 BRENTWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32206-6168
Mailing Address - Country:US
Mailing Address - Phone:904-353-1874
Mailing Address - Fax:
Practice Address - Street 1:1437 FLAGLER AVE
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32207-8516
Practice Address - Country:US
Practice Address - Phone:904-353-1874
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-18
Last Update Date:2008-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP1231171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLAP1231OtherSTATE LICENSE NUMBER