Provider Demographics
NPI:1154668135
Name:GRIFFIN, JACQULYN RENEE (APRN)
Entity type:Individual
Prefix:
First Name:JACQULYN
Middle Name:RENEE
Last Name:GRIFFIN
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1701 48TH ST STE 260
Mailing Address - Street 2:
Mailing Address - City:WEST DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50266-6726
Mailing Address - Country:US
Mailing Address - Phone:515-368-6380
Mailing Address - Fax:515-452-0565
Practice Address - Street 1:1960 SW MAGAZINE RD
Practice Address - Street 2:
Practice Address - City:ANKENY
Practice Address - State:IA
Practice Address - Zip Code:50023-2978
Practice Address - Country:US
Practice Address - Phone:515-368-6380
Practice Address - Fax:515-452-0565
Is Sole Proprietor?:No
Enumeration Date:2013-01-10
Last Update Date:2025-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAG120173363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health