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NPI Code Detail

MEDICARE: JACKIE TANNER GRIFFIN NP

MEDICARE: JACKIE TANNER GRIFFIN NP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LF0000XFamily Nurse Practitioner900292NC

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
12328528OTHERUNITED HEALTHCARE

General Provider Information

NPI Number : 1316922339
Entity Type Code : Individual
Provider Name (Legal Business Name) : JACKIE TANNER GRIFFIN NP
Provider Business Mailing Address
First Line : 3803 N ELM ST
Second Line :
City : GREENSBORO
State : NC
Zip : 27455-2593
Country : US
Telephone Number : 336-540-7075
Fax Number : 888-882-3919
Provider Business Practice Location Address
First Line : 3803 N ELM ST
Second Line :
City : GREENSBORO
State : NC
Zip : 27455-2593
Country : US
Telephone Number : 336-540-7075
Fax Number : 888-882-3919
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/13/2005
Last Update Date : 06/08/2015

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