Healthcare Provider Details

I. General information

NPI: 1861734832
Provider Name (Legal Business Name): LEANN NICOLE LONG ARNP CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/18/2013
Last Update Date: 04/12/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 N ORANGE AVE STE 710
ORLANDO FL
32801-5202
US

IV. Provider business mailing address

801 N ORANGE AVE STE 710
ORLANDO FL
32801-5202
US

V. Phone/Fax

Practice location:
  • Phone: 407-333-0496
  • Fax: 407-648-9404
Mailing address:
  • Phone: 407-333-0496
  • Fax: 407-648-9404

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License NumberARNP9238282
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: