Provider Demographics
NPI:1184188989
Name:GRIZZAFFI, GREGORY PAUL (NP)
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:PAUL
Last Name:GRIZZAFFI
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:37236 CORVETTE DR
Mailing Address - Street 2:
Mailing Address - City:PRAIRIEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70769-3308
Mailing Address - Country:US
Mailing Address - Phone:225-772-7321
Mailing Address - Fax:
Practice Address - Street 1:13406 AIRLINE HWY
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70817-5917
Practice Address - Country:US
Practice Address - Phone:225-753-7233
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-25
Last Update Date:2019-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA203424363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily