MEDICARE: KIMBERLY MARIE GRIFFIN AGACNP-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	363LA2100X	Acute Care Nurse Practitioner	5017506	NC
2	363LA2100X	Acute Care Nurse Practitioner	95005237	CA

General Provider Information

NPI Number	:	1881145852
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIMBERLY MARIE GRIFFIN AGACNP-BC

Provider Business Mailing Address
First Line	:	11234 ANDERSON ST
Second Line	:
City	:	LOMA LINDA
State	:	CA
Zip	:	92350-1716
Country	:	US
Telephone Number	:	909-558-4475
Fax Number	:

Provider Business Practice Location Address
First Line	:	11234 ANDERSON ST
Second Line	:
City	:	LOMA LINDA
State	:	CA
Zip	:	92354-2804
Country	:	US
Telephone Number	:	909-558-4475
Fax Number	:

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

Provider Enumeration Date	:	10/14/2016
Last Update Date	:	02/20/2026

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