Provider Demographics
NPI:1114583630
Name:GRIFFIN, JACQUELINE L (FNP-C)
Entity type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:L
Last Name:GRIFFIN
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6437 OLD TOWNPOINT RD
Mailing Address - Street 2:
Mailing Address - City:SUFFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23435-3480
Mailing Address - Country:US
Mailing Address - Phone:804-616-1304
Mailing Address - Fax:
Practice Address - Street 1:6437 OLD TOWNPOINT RD
Practice Address - Street 2:
Practice Address - City:SUFFOLK
Practice Address - State:VA
Practice Address - Zip Code:23435-3480
Practice Address - Country:US
Practice Address - Phone:804-616-1304
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-10
Last Update Date:2024-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0001199727163W00000X
VAF05190093363L00000X
NC5020110363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner