Provider Demographics
NPI:1912187832
Name:GRIFFIN, DEBRA K (AUD)
Entity Type:Individual
Prefix:MS
First Name:DEBRA
Middle Name:K
Last Name:GRIFFIN
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:183 NW VETERANS ST
Mailing Address - Street 2:
Mailing Address - City:LAKE CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32055-3936
Mailing Address - Country:US
Mailing Address - Phone:386-758-3222
Mailing Address - Fax:386-758-3101
Practice Address - Street 1:183 NW VETERANS ST
Practice Address - Street 2:
Practice Address - City:LAKE CITY
Practice Address - State:FL
Practice Address - Zip Code:32055-3936
Practice Address - Country:US
Practice Address - Phone:386-758-3222
Practice Address - Fax:386-758-3101
Is Sole Proprietor?:No
Enumeration Date:2007-11-08
Last Update Date:2015-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAY0000196231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL600239100Medicaid
FLS1069Medicare UPIN
FLAJO66AMedicare UPIN