Healthcare Provider Details

I. General information

NPI: 1154668135
Provider Name (Legal Business Name): JACQULYN RENEE GRIFFIN APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/10/2013
Last Update Date: 10/05/2025
Certification Date: 10/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1960 SW MAGAZINE RD
ANKENY IA
50023-2978
US

IV. Provider business mailing address

1701 48TH ST STE 260
WEST DES MOINES IA
50266-6726
US

V. Phone/Fax

Practice location:
  • Phone: 515-368-6380
  • Fax: 515-452-0565
Mailing address:
  • Phone: 515-368-6380
  • Fax: 515-452-0565

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberG120173
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: