Provider Demographics
NPI:1578665709
Name:GRIGGS, REBECCA ANNE (FNP)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:ANNE
Last Name:GRIGGS
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 SECURITY DR
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:TN
Mailing Address - Zip Code:38305-3626
Mailing Address - Country:US
Mailing Address - Phone:731-661-9163
Mailing Address - Fax:731-664-9916
Practice Address - Street 1:21 SECURITY DR
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:TN
Practice Address - Zip Code:38305-3626
Practice Address - Country:US
Practice Address - Phone:731-661-9163
Practice Address - Fax:731-664-9916
Is Sole Proprietor?:No
Enumeration Date:2006-09-01
Last Update Date:2014-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNRN0000134097363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
3642935Medicare ID - Type UnspecifiedCIGNA MEDICARE
Q67041Medicare UPIN