Provider Demographics
NPI:1649808197
Name:GRIFFIS, LEAANNE (APRN)
Entity type:Individual
Prefix:
First Name:LEAANNE
Middle Name:
Last Name:GRIFFIS
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10482 NEW KINGS RD
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32219-2418
Mailing Address - Country:US
Mailing Address - Phone:904-759-1183
Mailing Address - Fax:
Practice Address - Street 1:10482 NEW KINGS RD
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32219-2418
Practice Address - Country:US
Practice Address - Phone:904-759-1183
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-31
Last Update Date:2020-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9177187163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
08081963Other08081963