Provider Demographics
NPI:1518737576
Name:GRIFFIN, TIARRA LASHAE
Entity Type:Individual
Prefix:MS
First Name:TIARRA
Middle Name:LASHAE
Last Name:GRIFFIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5442 DISCHER ST
Mailing Address - Street 2:
Mailing Address - City:PHILA
Mailing Address - State:PA
Mailing Address - Zip Code:19124-1105
Mailing Address - Country:US
Mailing Address - Phone:267-872-8660
Mailing Address - Fax:
Practice Address - Street 1:5442 DISCHER ST
Practice Address - Street 2:
Practice Address - City:PHILA
Practice Address - State:PA
Practice Address - Zip Code:19124-1105
Practice Address - Country:US
Practice Address - Phone:267-872-8660
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-02
Last Update Date:2024-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA74033601251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health