Provider Demographics
NPI:1205375730
Name:HIGGINBOTHAM, TRACI (CRNP)
Entity type:Individual
Prefix:
First Name:TRACI
Middle Name:
Last Name:HIGGINBOTHAM
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:333 COMMERCE ST STE 700
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37201-1835
Mailing Address - Country:US
Mailing Address - Phone:615-627-2293
Mailing Address - Fax:888-494-2588
Practice Address - Street 1:2100 SOUTHBRIDGE PKWY STE 650
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35209-1302
Practice Address - Country:US
Practice Address - Phone:205-533-8902
Practice Address - Fax:855-737-5542
Is Sole Proprietor?:No
Enumeration Date:2017-02-16
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AL1-131304363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology