Provider Demographics
NPI:1235852864
Name:LONGORIA, YANNETH GUADALUPE (WHNP)
Entity Type:Individual
Prefix:
First Name:YANNETH
Middle Name:GUADALUPE
Last Name:LONGORIA
Suffix:
Gender:F
Credentials:WHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 GALLIE CUT
Mailing Address - Street 2:
Mailing Address - City:RICHMOND HILL
Mailing Address - State:GA
Mailing Address - Zip Code:31324-6375
Mailing Address - Country:US
Mailing Address - Phone:254-554-1457
Mailing Address - Fax:
Practice Address - Street 1:1870 ATLANTA HWY
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:GA
Practice Address - Zip Code:30504-5948
Practice Address - Country:US
Practice Address - Phone:770-534-0670
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-20
Last Update Date:2024-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
GARN258638363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program