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General NPI Number Information
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NPI Number | 1396186235
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Entity Type | Individual
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Provider Name | PATRICE JENEANE LONGWORTH NNP
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Gender | Female
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Dates
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Enumeration Date | 07/08/2013
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Last Update Date | 11/16/2022
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Provider Practice Location Address
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Address Line | 83 W MILLER ST
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City | ORLANDO
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State | FL
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Zip | 32806-2031
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Country | US
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Telephone | 321-841-5198
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Fax |
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Provider Business Mailing Address
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Address Line | 8466 RIVER BRANCH PL
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City | SANFORD
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State | FL
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Zip | 32771-8357
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Country | US
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Telephone | 407-925-1489
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Fax |
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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 | 363LN0000X
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Taxonomy Name | Neonatal Nurse Practitioner
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License Number | 9230232
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License Number State | FL
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