Healthcare Provider Details

I. General information

NPI: 1689683575
Provider Name (Legal Business Name): ALYSON LANG LONG ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/07/2006
Last Update Date: 07/07/2026
Certification Date: 07/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 SAINT ELIZABETH WAY STE 110
ST JOHNS FL
32259-1153
US

IV. Provider business mailing address

300 SAINT ELIZABETH WAY STE 110
ST JOHNS FL
32259-1153
US

V. Phone/Fax

Practice location:
  • Phone: 904-691-9100
  • Fax: 904-691-9129
Mailing address:
  • Phone: 904-691-9100
  • Fax: 904-691-9129

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberARNP3046612
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: