Provider Demographics
NPI:1225058464
Name:LONG, ERICA (PA)
Entity Type:Individual
Prefix:
First Name:ERICA
Middle Name:
Last Name:LONG
Suffix:
Gender:F
Credentials:PA
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Mailing Address - Street 1:410 42ND AVE N STE 400
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37209-3658
Mailing Address - Country:US
Mailing Address - Phone:615-329-7887
Mailing Address - Fax:615-346-6225
Practice Address - Street 1:660 S MOUNT JULIET RD STE 210
Practice Address - Street 2:
Practice Address - City:MT JULIET
Practice Address - State:TN
Practice Address - Zip Code:37122-3973
Practice Address - Country:US
Practice Address - Phone:615-443-0901
Practice Address - Fax:615-443-0310
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2023-08-25
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Provider Licenses
StateLicense IDTaxonomies
TNPA694363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
P00303Medicare UPIN