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General NPI Number Information
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NPI Number | 1679245914
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Entity Type | Individual
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Provider Name | JESSICA RENEE LONG APRN
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Gender | Female
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Dates
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Enumeration Date | 10/05/2021
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Last Update Date | 10/05/2021
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Provider Practice Location Address
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Address Line | 2122 UNIVERSITY BLVD S
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City | JACKSONVILLE
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State | FL
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Zip | 32216-8937
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Country | US
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Telephone | 904-398-5614
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Fax | 904-398-5617
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Provider Business Mailing Address
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Address Line | PO BOX 55009
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City | JACKSONVILLE
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State | FL
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Zip | 32216-0009
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Country | US
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Telephone | 904-398-5614
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Fax | 904-398-5617
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 11008692
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License Number State | FL
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