Provider Demographics
NPI:1093148991
Name:GRIFFIN, BRANDIE DIANNA (FNP)
Entity Type:Individual
Prefix:MRS
First Name:BRANDIE
Middle Name:DIANNA
Last Name:GRIFFIN
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2500 E HUNT DR STE H
Mailing Address - Street 2:
Mailing Address - City:SHOW LOW
Mailing Address - State:AZ
Mailing Address - Zip Code:85901-7954
Mailing Address - Country:US
Mailing Address - Phone:928-537-6937
Mailing Address - Fax:
Practice Address - Street 1:2500 E HUNT DR STE H
Practice Address - Street 2:
Practice Address - City:SHOW LOW
Practice Address - State:AZ
Practice Address - Zip Code:85901-7954
Practice Address - Country:US
Practice Address - Phone:928-537-6937
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-14
Last Update Date:2016-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP5227363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ854574Medicaid
AZZ184834Medicare PIN