Healthcare Provider Details

I. General information

NPI: 1447983051
Provider Name (Legal Business Name): HEATHER DANIELLE LONG DNP, APRN, FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/01/2022
Last Update Date: 07/23/2026
Certification Date: 07/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 MANATEE AVE W STE 202
BRADENTON FL
34205-8624
US

IV. Provider business mailing address

701 MANATEE AVE W STE 202
BRADENTON FL
34205-8624
US

V. Phone/Fax

Practice location:
  • Phone: 941-748-2455
  • Fax:
Mailing address:
  • Phone: 941-748-2455
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number11020503
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: