Provider Demographics
NPI:1073642963
Name:HIGGINS, JENNIFER C (MED, OTR)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:C
Last Name:HIGGINS
Suffix:
Gender:F
Credentials:MED, OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3311 W TYSON AVE
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33611-4315
Mailing Address - Country:US
Mailing Address - Phone:813-909-5219
Mailing Address - Fax:
Practice Address - Street 1:129 S PEBBLE BEACH BLVD
Practice Address - Street 2:SUITE 102
Practice Address - City:SUN CITY CENTER
Practice Address - State:FL
Practice Address - Zip Code:33573-5718
Practice Address - Country:US
Practice Address - Phone:813-633-6800
Practice Address - Fax:813-633-6801
Is Sole Proprietor?:No
Enumeration Date:2007-03-05
Last Update Date:2017-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT12393225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL891559800Medicaid