Provider Demographics
NPI:1043077936
Name:CHAN-LONG, YASMEEN ALYSSA (PA-C)
Entity Type:Individual
Prefix:
First Name:YASMEEN ALYSSA
Middle Name:
Last Name:CHAN-LONG
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:YASMEEN ALYSSA
Other - Middle Name:
Other - Last Name:CHAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:538 HAMILTON RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:MARYVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37801-2520
Mailing Address - Country:US
Mailing Address - Phone:904-859-3688
Mailing Address - Fax:
Practice Address - Street 1:538 HAMILTON RIDGE DR
Practice Address - Street 2:
Practice Address - City:MARYVILLE
Practice Address - State:TN
Practice Address - Zip Code:37801-2520
Practice Address - Country:US
Practice Address - Phone:904-859-3688
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-06
Last Update Date:2024-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant