Healthcare Provider Details

I. General information

NPI: 1629739990
Provider Name (Legal Business Name): JESSICA TERESA GRIFFIN HCA,RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/07/2022
Last Update Date: 01/07/2022
Certification Date: 01/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1080 SUMMIT TRAIL CIR APT C
WEST PALM BEACH FL
33415-4853
US

IV. Provider business mailing address

1080 SUMMIT TRAIL CIR APT C
WEST PALM BEACH FL
33415-4853
US

V. Phone/Fax

Practice location:
  • Phone: 561-818-9268
  • Fax:
Mailing address:
  • Phone: 561-818-9268
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WA2000X
TaxonomyAdministrator Registered Nurse
License NumberRN9288860
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: