Provider Demographics
NPI:1801614870
Name:MICHAEL D GRIFFIN APRN LLC
Entity type:Organization
Organization Name:MICHAEL D GRIFFIN APRN LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MIKE
Authorized Official - Middle Name:
Authorized Official - Last Name:GRIFFIN
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:321-200-0471
Mailing Address - Street 1:1930 SLOAN CT
Mailing Address - Street 2:
Mailing Address - City:ROCKLEDGE
Mailing Address - State:FL
Mailing Address - Zip Code:32955-6912
Mailing Address - Country:US
Mailing Address - Phone:321-487-2173
Mailing Address - Fax:
Practice Address - Street 1:1930 SLOAN CT
Practice Address - Street 2:
Practice Address - City:ROCKLEDGE
Practice Address - State:FL
Practice Address - Zip Code:32955-6912
Practice Address - Country:US
Practice Address - Phone:321-487-2173
Practice Address - Fax:321-926-5300
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-30
Last Update Date:2024-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty