Provider Demographics
NPI:1063929479
Name:GRIFFIN, MICHAEL D (APRN)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:D
Last Name:GRIFFIN
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:MICHAEL
Other - Middle Name:D
Other - Last Name:GRIFFIN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:APRN
Mailing Address - Street 1:1930 SLOAN CT
Mailing Address - Street 2:
Mailing Address - City:ROCKLEDGE
Mailing Address - State:FL
Mailing Address - Zip Code:32955-6912
Mailing Address - Country:US
Mailing Address - Phone:321-200-0471
Mailing Address - Fax:
Practice Address - Street 1:1930 SLOAN CT
Practice Address - Street 2:
Practice Address - City:ROCKLEDGE
Practice Address - State:FL
Practice Address - Zip Code:32955-6912
Practice Address - Country:US
Practice Address - Phone:321-200-0471
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-08
Last Update Date:2024-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9184553363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLARNP9184553OtherFLORIDA DEPT. OF HEALTH