Healthcare Provider Details

I. General information

NPI: 1063556363
Provider Name (Legal Business Name): QUANDA M GRIFFIN NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/19/2007
Last Update Date: 08/14/2026
Certification Date: 08/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

SOUTHEASTERN VIRGINIA HEALTH SYSTEMS-48TH STREET PHYSIC 4714 MARSHALL AVE
NEWPORT NEWS VA
23608
US

IV. Provider business mailing address

620 JOHN PAUL JONES CIR BLDG 104 NAVAL MEDICAL CENTER PORTSMOUTH
PORTSMOUTH VA
23708-2111
US

V. Phone/Fax

Practice location:
  • Phone: 757-380-8709
  • Fax: 757-952-1345
Mailing address:
  • Phone: 757-953-9822
  • Fax: 757-953-9999

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number0024168269
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number0001150167
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: