MEDICARE: MS. HEATHER GRIFFIN

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	237700000X	Hearing Instrument Specialist	AS5411	FL

General Provider Information

NPI Number	:	1710442934
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. HEATHER GRIFFIN

Provider Business Mailing Address
First Line	:	18997 US HIGHWAY 441
Second Line	:
City	:	MOUNT DORA
State	:	FL
Zip	:	32757-6735
Country	:	US
Telephone Number	:	321-863-3648
Fax Number	:

Provider Business Practice Location Address
First Line	:	18997 US HIGHWAY 441
Second Line	:
City	:	MOUNT DORA
State	:	FL
Zip	:	32757-6735
Country	:	US
Telephone Number	:	321-863-3648
Fax Number	:

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

Provider Enumeration Date	:	02/01/2019
Last Update Date	:	02/01/2019

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