Provider Demographics
NPI:1568659969
Name:GRIFFIN, RAENELLE LYNN (PA-C)
Entity type:Individual
Prefix:MRS
First Name:RAENELLE
Middle Name:LYNN
Last Name:GRIFFIN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MISS
Other - First Name:RAENELLE
Other - Middle Name:LYNN
Other - Last Name:PARKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:22968 TUCKAHOE SPRINGS DR
Mailing Address - Street 2:
Mailing Address - City:DENTON
Mailing Address - State:MD
Mailing Address - Zip Code:21629-1615
Mailing Address - Country:US
Mailing Address - Phone:757-284-9982
Mailing Address - Fax:
Practice Address - Street 1:316 RAILROAD AVE
Practice Address - Street 2:
Practice Address - City:GOLDSBORO
Practice Address - State:MD
Practice Address - Zip Code:21636-1126
Practice Address - Country:US
Practice Address - Phone:410-634-2380
Practice Address - Fax:410-482-7488
Is Sole Proprietor?:No
Enumeration Date:2007-09-28
Last Update Date:2014-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDC0003659363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant