Healthcare Provider Details

I. General information

NPI: 1932413747
Provider Name (Legal Business Name): TERRESA ANN LONG NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/04/2010
Last Update Date: 01/30/2025
Certification Date: 01/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

710 SUNSET BLVD N STE A
SUNSET BEACH NC
28468-4340
US

IV. Provider business mailing address

PO BOX 2123
BRYSON CITY NC
28713-5123
US

V. Phone/Fax

Practice location:
  • Phone: 910-663-2273
  • Fax: 910-663-4050
Mailing address:
  • Phone: 910-490-0490
  • Fax: 828-538-4441

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number5004840
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: