Provider Demographics
NPI:1265006811
Name:GRIFFIN, JULIE ANN (FNP-C)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:ANN
Last Name:GRIFFIN
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:188 POWDER MILL RD
Mailing Address - Street 2:
Mailing Address - City:CENTRAL
Mailing Address - State:SC
Mailing Address - Zip Code:29630-9540
Mailing Address - Country:US
Mailing Address - Phone:864-650-0253
Mailing Address - Fax:
Practice Address - Street 1:634 FAIRVIEW RD
Practice Address - Street 2:
Practice Address - City:SIMPSONVILLE
Practice Address - State:SC
Practice Address - Zip Code:29680-6707
Practice Address - Country:US
Practice Address - Phone:864-757-9720
Practice Address - Fax:864-757-9772
Is Sole Proprietor?:No
Enumeration Date:2021-05-18
Last Update Date:2021-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC24947363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC24947OtherSOUTH CAROLINA APRN LICENSE