Provider Demographics
NPI:1407747983
Name:GRIFFIN, TEQUILA M
Entity type:Individual
Prefix:
First Name:TEQUILA
Middle Name:M
Last Name:GRIFFIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1500 PARK ASHWOOD CIR APT D
Mailing Address - Street 2:
Mailing Address - City:SAINT CHARLES
Mailing Address - State:MO
Mailing Address - Zip Code:63304-7391
Mailing Address - Country:US
Mailing Address - Phone:314-707-3389
Mailing Address - Fax:
Practice Address - Street 1:1500 PARK ASHWOOD CIR APT D
Practice Address - Street 2:
Practice Address - City:SAINT CHARLES
Practice Address - State:MO
Practice Address - Zip Code:63304-7391
Practice Address - Country:US
Practice Address - Phone:314-707-3389
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-11
Last Update Date:2025-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOT035026007343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)