Provider Demographics
NPI:1942028782
Name:GIFFIN, MIKAYLA BRI ANA (LME)
Entity type:Individual
Prefix:
First Name:MIKAYLA
Middle Name:BRI ANA
Last Name:GIFFIN
Suffix:
Gender:F
Credentials:LME
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1925 GLENN MITCHELL DR STE 206
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23456-0177
Mailing Address - Country:US
Mailing Address - Phone:757-507-0720
Mailing Address - Fax:
Practice Address - Street 1:1925 GLENN MITCHELL DR STE 206
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23456-0177
Practice Address - Country:US
Practice Address - Phone:757-507-0720
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-01
Last Update Date:2024-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA1264002890208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery