Provider Demographics
NPI:1942632690
Name:GRIFFIN, TRACY L (STNA)
Entity Type:Individual
Prefix:
First Name:TRACY
Middle Name:L
Last Name:GRIFFIN
Suffix:
Gender:F
Credentials:STNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4605 ELM AVE
Mailing Address - Street 2:
Mailing Address - City:ASHTABULA
Mailing Address - State:OH
Mailing Address - Zip Code:44004-6829
Mailing Address - Country:US
Mailing Address - Phone:440-813-5234
Mailing Address - Fax:
Practice Address - Street 1:4605 ELM AVE
Practice Address - Street 2:
Practice Address - City:ASHTABULA
Practice Address - State:OH
Practice Address - Zip Code:44004-6829
Practice Address - Country:US
Practice Address - Phone:440-813-5234
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-05
Last Update Date:2013-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH322333220613376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide