Provider Demographics
NPI:1730873159
Name:LONG, TAYLOR A (DNP, APRN, CPNP-PC)
Entity type:Individual
Prefix:
First Name:TAYLOR
Middle Name:A
Last Name:LONG
Suffix:
Gender:F
Credentials:DNP, APRN, CPNP-PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16038 S 31ST ST
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85048-7721
Mailing Address - Country:US
Mailing Address - Phone:480-309-5236
Mailing Address - Fax:
Practice Address - Street 1:16611 S 40TH ST STE 160
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85048-0565
Practice Address - Country:US
Practice Address - Phone:480-940-8527
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-07
Last Update Date:2023-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ229094363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics