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General NPI Number Information
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NPI Number | 1710382841
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Entity Type | Organization
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Legal Business Name | J.R. GRIFFIN CRNFA LLC
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Dates
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Enumeration Date | 10/31/2014
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Last Update Date | 09/08/2019
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Provider Practice Location Address
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Address Line | 11811 N TATUM BLVD STE P199
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City | PHOENIX
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State | AZ
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Zip | 85028-1698
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Country | US
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Telephone | 480-720-6347
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Fax |
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Provider Business Mailing Address
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Address Line | 6501 E GREENWAY PKWY # 103-151
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City | SCOTTSDALE
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State | AZ
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Zip | 85254-2025
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Country | US
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Telephone | 480-720-6347
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Fax |
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Authorized Official
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Title or Position | OWNER/ PRESIDENT
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Name | JAY R GRIFFIN
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Credential | NP
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Telephone | 480-720-6347
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | AP7367
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License Number State | AZ
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