Provider Demographics
NPI:1164100988
Name:PALLIATIVE COACH
Entity Type:Organization
Organization Name:PALLIATIVE COACH
Other - Org Name:THE PALLIATIVE COACH
Other - Org Type:Other Name
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:DR
Authorized Official - First Name:JACKLYN
Authorized Official - Middle Name:
Authorized Official - Last Name:GRIFFIN
Authorized Official - Suffix:
Authorized Official - Credentials:ACNP-BC
Authorized Official - Phone:586-420-1117
Mailing Address - Street 1:24889 BEACH DR
Mailing Address - Street 2:
Mailing Address - City:MACOMB
Mailing Address - State:MI
Mailing Address - Zip Code:48042-4558
Mailing Address - Country:US
Mailing Address - Phone:586-420-1117
Mailing Address - Fax:
Practice Address - Street 1:6305 NAPLES BLVD
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34109-2071
Practice Address - Country:US
Practice Address - Phone:586-420-1117
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-11
Last Update Date:2023-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Single Specialty