Provider Demographics
NPI:1710382841
Name:J.R. GRIFFIN CRNFA LLC
Entity Type:Organization
Organization Name:J.R. GRIFFIN CRNFA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JAY
Authorized Official - Middle Name:R
Authorized Official - Last Name:GRIFFIN
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:480-720-6347
Mailing Address - Street 1:6501 E GREENWAY PKWY # 103-151
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85254-2025
Mailing Address - Country:US
Mailing Address - Phone:480-720-6347
Mailing Address - Fax:
Practice Address - Street 1:11811 N TATUM BLVD STE P199
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85028-1698
Practice Address - Country:US
Practice Address - Phone:480-720-6347
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-31
Last Update Date:2019-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP7367363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty