Provider Demographics
NPI:1316942881
Name:HIGGINS, VICKY J (FNPC)
Entity type:Individual
Prefix:MRS
First Name:VICKY
Middle Name:J
Last Name:HIGGINS
Suffix:
Gender:F
Credentials:FNPC
Other - Prefix:MRS
Other - First Name:VICKY
Other - Middle Name:J
Other - Last Name:JANOS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNPC
Mailing Address - Street 1:4100 JERRY MURPHY RD
Mailing Address - Street 2:
Mailing Address - City:PUEBLO
Mailing Address - State:CO
Mailing Address - Zip Code:81001-1076
Mailing Address - Country:US
Mailing Address - Phone:719-545-9713
Mailing Address - Fax:719-545-2054
Practice Address - Street 1:4100 JERRY MURPHY RD
Practice Address - Street 2:
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81001-1076
Practice Address - Country:US
Practice Address - Phone:719-545-9713
Practice Address - Fax:719-545-2054
Is Sole Proprietor?:No
Enumeration Date:2005-06-20
Last Update Date:2008-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO50850363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO70432236Medicaid
CO70432236Medicaid
CO365238Medicare ID - Type UnspecifiedMEDICARE LIC