Provider Demographics
NPI:1699215228
Name:GRIFFIS, TIFFANY B (NP-C)
Entity Type:Individual
Prefix:
First Name:TIFFANY
Middle Name:B
Last Name:GRIFFIS
Suffix:
Gender:F
Credentials:NP-C
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 1148
Mailing Address - Street 2:
Mailing Address - City:POTEAU
Mailing Address - State:OK
Mailing Address - Zip Code:74953-1148
Mailing Address - Country:US
Mailing Address - Phone:918-635-3192
Mailing Address - Fax:918-635-3308
Practice Address - Street 1:1013 DEWEY AVE
Practice Address - Street 2:
Practice Address - City:POTEAU
Practice Address - State:OK
Practice Address - Zip Code:74953-4409
Practice Address - Country:US
Practice Address - Phone:918-647-2929
Practice Address - Fax:918-647-2288
Is Sole Proprietor?:No
Enumeration Date:2017-03-01
Last Update Date:2019-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK76959363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200825590Medicaid