Provider Demographics
NPI:1740733096
Name:GRIFFIN, JESSICA (FNP-C)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:GRIFFIN
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4500 SOJOURN DR APT 510C
Mailing Address - Street 2:
Mailing Address - City:ADDISON
Mailing Address - State:TX
Mailing Address - Zip Code:75001-5006
Mailing Address - Country:US
Mailing Address - Phone:314-435-7055
Mailing Address - Fax:
Practice Address - Street 1:529 N GALLOWAY AVE
Practice Address - Street 2:SUITE #16
Practice Address - City:MESQUITE
Practice Address - State:TX
Practice Address - Zip Code:75149-3420
Practice Address - Country:US
Practice Address - Phone:972-566-7163
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-03
Last Update Date:2019-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP131486363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily