Provider Demographics
NPI:1114670403
Name:GRIFFIN, KATHANELL LYNETTE
Entity Type:Individual
Prefix:MRS
First Name:KATHANELL
Middle Name:LYNETTE
Last Name:GRIFFIN
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 1:710 OAKFIELD DR STE 210
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:FL
Mailing Address - Zip Code:33511-4924
Mailing Address - Country:US
Mailing Address - Phone:813-662-4043
Mailing Address - Fax:
Practice Address - Street 1:710 OAKFIELD DR STE 210
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33511-4924
Practice Address - Country:US
Practice Address - Phone:813-662-4043
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-27
Last Update Date:2022-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL251C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services