Provider Demographics
NPI:1134434053
Name:GRIFFY, LARA E (ANP)
Entity type:Individual
Prefix:
First Name:LARA
Middle Name:E
Last Name:GRIFFY
Suffix:
Gender:F
Credentials:ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13737 NOEL RD
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75240-1331
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:12371 EDGEMERE BLVD
Practice Address - Street 2:SUITE 207
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79938-4877
Practice Address - Country:US
Practice Address - Phone:915-856-0008
Practice Address - Fax:915-856-0022
Is Sole Proprietor?:No
Enumeration Date:2010-08-16
Last Update Date:2016-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX745884363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner