Provider Demographics
NPI:1619177516
Name:GRIFFIN, TISHA R (CRNP)
Entity Type:Individual
Prefix:
First Name:TISHA
Middle Name:R
Last Name:GRIFFIN
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:431 N CARLISLE ST
Mailing Address - Street 2:
Mailing Address - City:ALBERTVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35950-1733
Mailing Address - Country:US
Mailing Address - Phone:256-251-2566
Mailing Address - Fax:256-344-8334
Practice Address - Street 1:431 N CARLISLE ST
Practice Address - Street 2:
Practice Address - City:ALBERTVILLE
Practice Address - State:AL
Practice Address - Zip Code:35950-1733
Practice Address - Country:US
Practice Address - Phone:256-251-2566
Practice Address - Fax:256-344-8334
Is Sole Proprietor?:No
Enumeration Date:2007-07-19
Last Update Date:2022-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1098638363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily