Provider Demographics
NPI:1114679123
Name:MCGRIFF, SERALL ELISE (HCA/NURSE)
Entity Type:Individual
Prefix:
First Name:SERALL
Middle Name:ELISE
Last Name:MCGRIFF
Suffix:
Gender:F
Credentials:HCA/NURSE
Other - Prefix:MRS
Other - First Name:SERALL
Other - Middle Name:
Other - Last Name:MCGRIFF
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:HCA/NURSE
Mailing Address - Street 1:501 VALE LOOP
Mailing Address - Street 2:
Mailing Address - City:CRESTVIEW
Mailing Address - State:FL
Mailing Address - Zip Code:32536-5467
Mailing Address - Country:US
Mailing Address - Phone:850-865-6366
Mailing Address - Fax:
Practice Address - Street 1:501 VALE LOOP
Practice Address - Street 2:
Practice Address - City:CRESTVIEW
Practice Address - State:FL
Practice Address - Zip Code:32536-5467
Practice Address - Country:US
Practice Address - Phone:850-865-6366
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-20
Last Update Date:2022-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL372600000X, 374U00000X, 376J00000X, 376K00000X
FL1233171164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
No372600000XNursing Service Related ProvidersAdult Companion
No374U00000XNursing Service Related ProvidersHome Health Aide
No376J00000XNursing Service Related ProvidersHomemaker
No376K00000XNursing Service Related ProvidersNurse's Aide