Provider Demographics
NPI:1861734832
Name:LONG, LEANN NICOLE (ARNP CNM)
Entity type:Individual
Prefix:
First Name:LEANN
Middle Name:NICOLE
Last Name:LONG
Suffix:
Gender:F
Credentials:ARNP CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:801 N ORANGE AVE STE 710
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32801-5202
Mailing Address - Country:US
Mailing Address - Phone:407-333-0496
Mailing Address - Fax:407-648-9404
Practice Address - Street 1:801 N ORANGE AVE STE 710
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32801-5202
Practice Address - Country:US
Practice Address - Phone:407-333-0496
Practice Address - Fax:407-648-9404
Is Sole Proprietor?:No
Enumeration Date:2013-03-18
Last Update Date:2018-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9238282363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology