1083133318 NPI number — MRS. MELISSA MONIQUE GRIFFIN FNP

Table of content: MRS. MELISSA MONIQUE GRIFFIN FNP (NPI 1083133318)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1083133318 NPI number — MRS. MELISSA MONIQUE GRIFFIN FNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GRIFFIN
Provider First Name:
MELISSA
Provider Middle Name:
MONIQUE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
FNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1083133318
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/05/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
660 DOVER STREET
Provider Second Line Business Mailing Address:
APT A10
Provider Business Mailing Address City Name:
BOCA RATON
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33487
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-726-7943
Provider Business Mailing Address Fax Number:
240-324-7720

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2085 VISTA PARKWAY
Provider Second Line Business Practice Location Address:
NURSING DEPARTMENT
Provider Business Practice Location Address City Name:
WEST PALM BEACH
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33411
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
561-471-6000
Provider Business Practice Location Address Fax Number:
561-471-7849
Provider Enumeration Date:
09/19/2017

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 163W00000X , with the licence number:  R169067 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LF0000X , with the licence number: R169067 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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