Provider Demographics
NPI:1255437497
Name:GRIFFIN, VIRGINIA ROSS (PA-C)
Entity type:Individual
Prefix:
First Name:VIRGINIA
Middle Name:ROSS
Last Name:GRIFFIN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:VIRGINIA
Other - Middle Name:CATHERINE
Other - Last Name:ROSS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:19401 N CAVE CREEK RD
Mailing Address - Street 2:#18
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85024-1801
Mailing Address - Country:US
Mailing Address - Phone:602-996-0099
Mailing Address - Fax:
Practice Address - Street 1:19401 N CAVE CREEK RD
Practice Address - Street 2:#18
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85024-1801
Practice Address - Country:US
Practice Address - Phone:602-996-0099
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-15
Last Update Date:2014-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ2638363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant