Healthcare Provider Details

I. General information

NPI: 1649808197
Provider Name (Legal Business Name): LEAANNE GRIFFIS APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/31/2020
Last Update Date: 03/31/2020
Certification Date: 03/31/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10482 NEW KINGS RD
JACKSONVILLE FL
32219-2418
US

IV. Provider business mailing address

10482 NEW KINGS RD
JACKSONVILLE FL
32219-2418
US

V. Phone/Fax

Practice location:
  • Phone: 904-759-1183
  • Fax:
Mailing address:
  • Phone: 904-759-1183
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License NumberRN9177187
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: