Provider Demographics
NPI:1447991906
Name:HIGGINS, KRYSTALLE MARIE
Entity type:Individual
Prefix:MS
First Name:KRYSTALLE
Middle Name:MARIE
Last Name:HIGGINS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9320 BELAIRE DR
Mailing Address - Street 2:
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33025-3880
Mailing Address - Country:US
Mailing Address - Phone:305-721-8863
Mailing Address - Fax:
Practice Address - Street 1:9320 BELAIRE DR
Practice Address - Street 2:
Practice Address - City:MIRAMAR
Practice Address - State:FL
Practice Address - Zip Code:33025-3880
Practice Address - Country:US
Practice Address - Phone:305-721-8863
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-06
Last Update Date:2022-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPN5229135164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse