Provider Demographics
NPI:1952913188
Name:GRIFFIN, MARJORIE (AGACNP)
Entity Type:Individual
Prefix:
First Name:MARJORIE
Middle Name:
Last Name:GRIFFIN
Suffix:
Gender:F
Credentials:AGACNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:317 BENTLEY DRIVE
Mailing Address - Street 2:ADDRESS LINE 2
Mailing Address - City:JOSHUA
Mailing Address - State:TX
Mailing Address - Zip Code:76058
Mailing Address - Country:US
Mailing Address - Phone:817-880-5549
Mailing Address - Fax:
Practice Address - Street 1:701 S NEDDERMAN DR
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76019-9800
Practice Address - Country:US
Practice Address - Phone:817-272-2011
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-19
Last Update Date:2020-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2019080422363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care