Provider Demographics
NPI:1619990215
Name:GRIFFIN, SUSAN (ARNP)
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:
Last Name:GRIFFIN
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:131 E REDSTONE AVE
Mailing Address - Street 2:SUITE 109
Mailing Address - City:CRESTVIEW
Mailing Address - State:FL
Mailing Address - Zip Code:32539-5326
Mailing Address - Country:US
Mailing Address - Phone:850-683-1100
Mailing Address - Fax:850-689-0599
Practice Address - Street 1:131 E REDSTONE AVE
Practice Address - Street 2:SUITE 109
Practice Address - City:CRESTVIEW
Practice Address - State:FL
Practice Address - Zip Code:32539-5326
Practice Address - Country:US
Practice Address - Phone:850-683-1100
Practice Address - Fax:850-683-0599
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2010-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN1182012363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology