Provider Demographics
NPI:1073602348
Name:GRIFFIN, JENNIFER APPLE (MSN,APRN,BC,ANP,GNP)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:APPLE
Last Name:GRIFFIN
Suffix:
Gender:F
Credentials:MSN,APRN,BC,ANP,GNP
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Mailing Address - Street 1:520 MAPLE AVE
Mailing Address - Street 2:SUITE C
Mailing Address - City:REIDSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27320-4652
Mailing Address - Country:US
Mailing Address - Phone:336-342-6063
Mailing Address - Fax:336-342-7847
Practice Address - Street 1:520 MAPLE AVE
Practice Address - Street 2:SUITE C
Practice Address - City:REIDSVILLE
Practice Address - State:NC
Practice Address - Zip Code:27320-4652
Practice Address - Country:US
Practice Address - Phone:336-342-6063
Practice Address - Fax:336-342-6066
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2021-08-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC0050-00502363LA2200X, 363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
170C1OtherBCBS
NC1073602348Medicaid
170C1OtherBCBS
NC5926D411Medicare PIN