Provider Demographics
NPI:1114711983
Name:HIGGINS, ISABELLE DIANE
Entity type:Individual
Prefix:
First Name:ISABELLE
Middle Name:DIANE
Last Name:HIGGINS
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17925 FATTORIA TER
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34211-2846
Mailing Address - Country:US
Mailing Address - Phone:631-655-6333
Mailing Address - Fax:
Practice Address - Street 1:17925 FATTORIA TER
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34211-2846
Practice Address - Country:US
Practice Address - Phone:631-655-6333
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-07
Last Update Date:2025-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No133VN1501XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Sports Dietetics