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General NPI Number Information
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NPI Number | 1710603527
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Entity Type | Individual
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Provider Name | KRISTA BLAU LONGMORE FNP-C
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Gender | Female
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Dates
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Enumeration Date | 10/13/2022
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Last Update Date | 12/13/2022
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Provider Practice Location Address
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Address Line | 2020 59TH ST W
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City | BRADENTON
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State | FL
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Zip | 34209-4604
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Country | US
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Telephone | 941-792-6611
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Fax |
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Provider Business Mailing Address
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Address Line | 5860 RANCH LAKE BLVD STE 200
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City | BRADENTON
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State | FL
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Zip | 34202-3719
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Country | US
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Telephone | 941-388-8997
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 660740
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License Number State | FL
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