MEDICARE: MS. CAROL GRIFFITHS APRN, BC

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	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	APRN752702	FL

General Provider Information

NPI Number	:	1285650499
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. CAROL GRIFFITHS APRN, BC

Provider Business Mailing Address
First Line	:	1039 GRAND CANYON DR
Second Line	:
City	:	VALRICO
State	:	FL
Zip	:	33594-4353
Country	:	US
Telephone Number	:	813-979-3562
Fax Number	:	813-979-3536

Provider Business Practice Location Address
First Line	:	10770 N 46TH ST
Second Line	:	C-100
City	:	TAMPA
State	:	FL
Zip	:	33617-3442
Country	:	US
Telephone Number	:	813-979-3562
Fax Number	:	813-979-3536

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

Provider Enumeration Date	:	07/14/2006
Last Update Date	:	07/08/2007

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