Provider Demographics
NPI:1164839494
Name:LONG, AMY MARIA (MSN APRN FNP-C)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:MARIA
Last Name:LONG
Suffix:
Gender:F
Credentials:MSN APRN FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1755 GUNBARREL RD
Mailing Address - Street 2:SUITE 209
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37421-7137
Mailing Address - Country:US
Mailing Address - Phone:423-778-8478
Mailing Address - Fax:423-778-8479
Practice Address - Street 1:1755 GUNBARREL RD
Practice Address - Street 2:SUITE 209
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37421-7137
Practice Address - Country:US
Practice Address - Phone:423-778-8478
Practice Address - Fax:423-778-8479
Is Sole Proprietor?:No
Enumeration Date:2014-07-18
Last Update Date:2014-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN18809363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily