Healthcare Provider Details

I. General information

NPI: 1326581570
Provider Name (Legal Business Name): ROSANNAH LONG
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/21/2016
Last Update Date: 09/02/2026
Certification Date: 09/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6866 WILSON HAMMOCK AVE
GROVELAND FL
34736-8164
US

IV. Provider business mailing address

6866 WILSON HAMMOCK AVE
GROVELAND FL
34736-8164
US

V. Phone/Fax

Practice location:
  • Phone: 407-729-1196
  • Fax:
Mailing address:
  • Phone: 407-729-1196
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: