Provider Demographics
NPI:1619521614
Name:GRIZZLE, ASHLEIGH DANIELLE (MSN, APRN, FNP-C)
Entity Type:Individual
Prefix:
First Name:ASHLEIGH
Middle Name:DANIELLE
Last Name:GRIZZLE
Suffix:
Gender:F
Credentials:MSN, APRN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:245 FOREST RD
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:GA
Mailing Address - Zip Code:30605-3817
Mailing Address - Country:US
Mailing Address - Phone:678-230-4902
Mailing Address - Fax:
Practice Address - Street 1:1424 HIGHWAY 98 W
Practice Address - Street 2:
Practice Address - City:DANIELSVILLE
Practice Address - State:GA
Practice Address - Zip Code:30633-5356
Practice Address - Country:US
Practice Address - Phone:706-795-2131
Practice Address - Fax:706-795-2632
Is Sole Proprietor?:No
Enumeration Date:2019-07-29
Last Update Date:2019-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN236102363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily