MEDICARE: SARAH GANO LONGO NP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LX0106X	Occupational Health Nurse Practitioner	31262	TN
2	363LF0000X	Family Nurse Practitioner	F03210201	TN

General Provider Information

NPI Number	:	1578138723
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SARAH GANO LONGO NP

Provider Business Mailing Address
First Line	:	324 WILKINSON PL
Second Line	:
City	:	MEMPHIS
State	:	TN
Zip	:	38111-6126
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	7205 WOLF RIVER BLVD
Second Line	:
City	:	GERMANTOWN
State	:	TN
Zip	:	38138-1758
Country	:	US
Telephone Number	:	901-969-9115
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/20/2021
Last Update Date	:	01/07/2026

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