Provider Demographics
NPI:1518328749
Name:GRIFFIN, JESSICA A (NP)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:A
Last Name:GRIFFIN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32 MALLETTS BAY AVE STE B
Mailing Address - Street 2:
Mailing Address - City:WINOOSKI
Mailing Address - State:VT
Mailing Address - Zip Code:05404-1960
Mailing Address - Country:US
Mailing Address - Phone:802-655-4422
Mailing Address - Fax:
Practice Address - Street 1:32 MALLETTS BAY AVE STE B
Practice Address - Street 2:
Practice Address - City:WINOOSKI
Practice Address - State:VT
Practice Address - Zip Code:05404-1960
Practice Address - Country:US
Practice Address - Phone:802-655-4422
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-03-16
Last Update Date:2023-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2306074163W00000X
VT101.0132807363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse