Healthcare Provider Details

I. General information

NPI: 1942006069
Provider Name (Legal Business Name): LONG MEDICAL PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/20/2025
Last Update Date: 07/16/2025
Certification Date: 07/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3614 KIESSEL RD
THE VILLAGES FL
32163-2910
US

IV. Provider business mailing address

3614 KIESSEL RD
THE VILLAGES FL
32163-2910
US

V. Phone/Fax

Practice location:
  • Phone: 352-914-3451
  • Fax: 352-415-3952
Mailing address:
  • Phone: 352-914-3451
  • Fax: 352-415-3952

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207ND0101X
TaxonomyMOHS-Micrographic Surgery Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207NS0135X
TaxonomyProcedural Dermatology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. TYLER JON LONG
Title or Position: OWNER/PHYSICIAN
Credential: DO
Phone: 352-914-3451