Healthcare Provider Details

I. General information

NPI: 1114583630
Provider Name (Legal Business Name): JACQUELINE L GRIFFIN FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/10/2019
Last Update Date: 03/17/2026
Certification Date: 03/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3001 JEFFERSON AVE
NEWPORT NEWS VA
23607-3401
US

IV. Provider business mailing address

3001 JEFFERSON AVE
NEWPORT NEWS VA
23607-3401
US

V. Phone/Fax

Practice location:
  • Phone: 757-330-5846
  • Fax: 877-975-7837
Mailing address:
  • Phone: 757-330-5846
  • Fax: 877-975-7837

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number0024177784
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number5020110
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number0001199727
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: