Provider Demographics
NPI:1700340429
Name:GRIFFITH, LAURA
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:GRIFFITH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 S SYKES CREEK PKWY APT A210
Mailing Address - Street 2:
Mailing Address - City:MERRITT IS
Mailing Address - State:FL
Mailing Address - Zip Code:32952-3579
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:200 S SYKES CREEK PKWY
Practice Address - Street 2:
Practice Address - City:MERRITT IS
Practice Address - State:FL
Practice Address - Zip Code:32952-3561
Practice Address - Country:US
Practice Address - Phone:321-480-0099
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-27
Last Update Date:2019-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2019002148364SA2100X
FL11001036364SA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SA2100XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistAcute Care