MEDICARE: MRS. RACHEL GRIFFIN PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	0010-04286	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	010-04286	OTHER	NC	NC MEDICAL LICENSE

General Provider Information

NPI Number	:	1073951406
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. RACHEL GRIFFIN PA-C

Provider Business Mailing Address
First Line	:	2675 WINKLER AVE STE 201
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33901-9328
Country	:	US
Telephone Number	:	877-856-3774
Fax Number	:	239-599-2612

Provider Business Practice Location Address
First Line	:	11009 INGLESIDE PL STE 201
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27614-6697
Country	:	US
Telephone Number	:	919-844-4344
Fax Number	:	919-844-3244

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/07/2013
Last Update Date	:	10/07/2025

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