Healthcare Provider Details

I. General information

NPI: 1235471178
Provider Name (Legal Business Name): AMANDA JO GRIFFIN CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/19/2013
Last Update Date: 02/13/2022
Certification Date: 02/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3525 OLENTANGY RIVER RD STE 4330
COLUMBUS OH
43214-3937
US

IV. Provider business mailing address

51 JAMESTOWN RD PO BOX 253
SOUTH CHARLESTON OH
45368-5031
US

V. Phone/Fax

Practice location:
  • Phone: 614-255-6900
  • Fax:
Mailing address:
  • Phone: 937-624-9873
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN.392314
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License NumberPN.123058-IV
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License NumberRN.392314
License Number StateOH
# 4
Primary TaxonomyN
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License NumberRN.392314
License Number StateOH
# 5
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberAPRN.CNP.0030618
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: