Provider Demographics
NPI:1861592255
Name:GRIFFIN, CONNIE (NP)
Entity type:Individual
Prefix:
First Name:CONNIE
Middle Name:
Last Name:GRIFFIN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:CONNIE
Other - Middle Name:
Other - Last Name:VINEYARD
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 56
Mailing Address - Street 2:
Mailing Address - City:LINDEN
Mailing Address - State:TN
Mailing Address - Zip Code:37096-0056
Mailing Address - Country:US
Mailing Address - Phone:931-589-2600
Mailing Address - Fax:931-589-2602
Practice Address - Street 1:847 SQUIRREL HOLLOW DRIVE
Practice Address - Street 2:
Practice Address - City:LINDEN
Practice Address - State:TN
Practice Address - Zip Code:37096
Practice Address - Country:US
Practice Address - Phone:931-589-2600
Practice Address - Fax:931-589-2602
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-25
Last Update Date:2014-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN10449363LP2300X, 261QR1300X
TNAPN0000010449363L00000X
TNTN10449363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
P18059Medicare UPIN