Provider Demographics
NPI:1629534870
Name:GRIFFITH, KAITLAN (PA)
Entity Type:Individual
Prefix:
First Name:KAITLAN
Middle Name:
Last Name:GRIFFITH
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 55156
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33732-5156
Mailing Address - Country:US
Mailing Address - Phone:727-577-1203
Mailing Address - Fax:727-578-2322
Practice Address - Street 1:5565 DR MARTIN LUTHER KING JR ST N
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33703-1203
Practice Address - Country:US
Practice Address - Phone:727-577-1203
Practice Address - Fax:727-578-2322
Is Sole Proprietor?:No
Enumeration Date:2019-02-13
Last Update Date:2019-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9111929363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant