Provider Demographics
NPI:1558433516
Name:GRIFFIN, JAN JOHNSON (NP)
Entity Type:Individual
Prefix:MS
First Name:JAN
Middle Name:JOHNSON
Last Name:GRIFFIN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:MS
Other - First Name:JAN
Other - Middle Name:JOHNSON
Other - Last Name:GRIFFIN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:NP
Mailing Address - Street 1:391 TAYLOR BLVD
Mailing Address - Street 2:SUITE 250
Mailing Address - City:PLEASANT HILL
Mailing Address - State:CA
Mailing Address - Zip Code:94523-2294
Mailing Address - Country:US
Mailing Address - Phone:925-688-8910
Mailing Address - Fax:925-688-2200
Practice Address - Street 1:391 TAYLOR BLVD
Practice Address - Street 2:SUITE 250
Practice Address - City:PLEASANT HILL
Practice Address - State:CA
Practice Address - Zip Code:94523-2294
Practice Address - Country:US
Practice Address - Phone:925-688-8910
Practice Address - Fax:925-688-2200
Is Sole Proprietor?:No
Enumeration Date:2006-11-14
Last Update Date:2011-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA10151363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health