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 1:1040 BARONET DR
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89138-8015
Mailing Address - Country:US
Mailing Address - Phone:702-513-3260
Mailing Address - Fax:
Practice Address - Street 1:2010 WELLNESS WAY STE 200
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89106-4142
Practice Address - Country:US
Practice Address - Phone:702-877-0814
Practice Address - Fax:702-877-3238
Is Sole Proprietor?:No
Enumeration Date:2019-05-23
Last Update Date:2022-03-14
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