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General NPI Number Information
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NPI Number | 1083653869
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Entity Type | Individual
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Provider Name | DIANE PAIGE LONG APRN
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Gender | Female
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Dates
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Enumeration Date | 06/06/2006
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Last Update Date | 07/19/2024
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Provider Practice Location Address
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Address Line | 1405 CLIFTON RD NE
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City | ATLANTA
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State | GA
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Zip | 30322-4634
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Country | US
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Telephone | 404-785-6395
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Fax | 404-785-1994
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Provider Business Mailing Address
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Address Line | 601 5TH ST S CARDIOLOGY
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City | ST PETERSBURG
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State | FL
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Zip | 33701-4804
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Country | US
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Telephone | 727-767-4954
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Fax | 727-767-2880
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0200X
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Taxonomy Name | Pediatric Nurse Practitioner
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License Number | F381443
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 363LP0200X
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Taxonomy Name | Pediatric Nurse Practitioner
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License Number | ARNP 9246874
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 363LP0200X
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Taxonomy Name | Pediatric Nurse Practitioner
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License Number | RN280201
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License Number State | GA
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