Provider Demographics
NPI:1790541472
Name:GRIFFITH, TINA LOUISE
Entity Type:Individual
Prefix:
First Name:TINA
Middle Name:LOUISE
Last Name:GRIFFITH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2223 N HADLEY RD
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:45505-4410
Mailing Address - Country:US
Mailing Address - Phone:937-215-7367
Mailing Address - Fax:
Practice Address - Street 1:2223 N HADLEY RD
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:OH
Practice Address - Zip Code:45505-4410
Practice Address - Country:US
Practice Address - Phone:937-215-7367
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-21
Last Update Date:2024-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide