Healthcare Provider Details

I. General information

NPI: 1598698482
Provider Name (Legal Business Name): LAURA ASHLEY GRIFFIS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2026
Last Update Date: 06/08/2026
Certification Date: 06/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2134 NW COUNTY ROAD 225
LAWTEY FL
32058-3757
US

IV. Provider business mailing address

2134 NW COUNTY ROAD 225
LAWTEY FL
32058-3757
US

V. Phone/Fax

Practice location:
  • Phone: 904-509-9070
  • Fax:
Mailing address:
  • Phone: 904-509-9070
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN11043255
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: