Provider Demographics
NPI:1902463003
Name:HIGGINSON, JONATHAN (APRN)
Entity type:Individual
Prefix:
First Name:JONATHAN
Middle Name:
Last Name:HIGGINSON
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7150 W SUNSET RD STE 200
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89113-1982
Mailing Address - Country:US
Mailing Address - Phone:702-385-4342
Mailing Address - Fax:702-385-4346
Practice Address - Street 1:3150 N TENAYA WAY STE 480
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89128-0494
Practice Address - Country:US
Practice Address - Phone:702-577-0024
Practice Address - Fax:702-608-4737
Is Sole Proprietor?:No
Enumeration Date:2019-05-23
Last Update Date:2024-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV820636363LF0000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVRN84307OtherNEVADA STATE BOARD OF NURSING
NV820636OtherNEVADA STATE BOARD OF NURSING