Healthcare Provider Details

I. General information

NPI: 1861584401
Provider Name (Legal Business Name): GORDAYNE E GRIFFIN FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: GORDAYNE EGBERT

II. Dates (important events)

Enumeration Date: 09/29/2006
Last Update Date: 08/16/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

706 PINEYWOOD RD
THOMASVILLE NC
27360-2753
US

IV. Provider business mailing address

PO BOX 10414
LARGO FL
33773-0414
US

V. Phone/Fax

Practice location:
  • Phone: 800-632-6074
  • Fax: 866-341-7509
Mailing address:
  • Phone: 800-632-6074
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License NumberRN034545
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number200735
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: