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NPI Code Detail

MEDICARE: VANESSA V LONGACRE APRN

MEDICARE: VANESSA V LONGACRE APRN
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LF0000XFamily Nurse Practitioner3005988KY
2363LF0000XFamily Nurse Practitioner71000901AIN
3363LF0000XFamily Nurse PractitionerAPRN9493697FL
4363L00000XNurse PractitionerAPRN9493697FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1841262011
Entity Type Code : Individual
Provider Name (Legal Business Name) : VANESSA V LONGACRE APRN
Provider Business Mailing Address
First Line : PO BOX 746638
Second Line :
City : ATLANTA
State : GA
Zip : 30374-6638
Country : US
Telephone Number : 904-202-2092
Fax Number : 904-376-4075
Provider Business Practice Location Address
First Line : 1660 PRUDENTIAL DR STE 400
Second Line :
City : JACKSONVILLE
State : FL
Zip : 32207-8188
Country : US
Telephone Number : 904-396-0000
Fax Number : 904-390-7500
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/02/2006
Last Update Date : 09/30/2024

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Directions to “ VANESSA V LONGACRE APRN” Practice Location

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