Provider Demographics
NPI:1376817536
Name:LONG, CONSTANCE SABRINA (PA)
Entity Type:Individual
Prefix:
First Name:CONSTANCE
Middle Name:SABRINA
Last Name:LONG
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Gender:F
Credentials:PA
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Mailing Address - Street 1:326 N LOCUST AVE
Mailing Address - Street 2:STE B
Mailing Address - City:LAWRENCEBURG
Mailing Address - State:TN
Mailing Address - Zip Code:38464-3516
Mailing Address - Country:US
Mailing Address - Phone:931-762-9797
Mailing Address - Fax:931-762-9798
Practice Address - Street 1:912 W COLLEGE ST
Practice Address - Street 2:
Practice Address - City:PULASKI
Practice Address - State:TN
Practice Address - Zip Code:38478-3630
Practice Address - Country:US
Practice Address - Phone:931-424-9797
Practice Address - Fax:931-424-9788
Is Sole Proprietor?:No
Enumeration Date:2012-03-05
Last Update Date:2020-02-17
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Provider Licenses
StateLicense IDTaxonomies
TN2040363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant