Provider Demographics
NPI:1417188707
Name:LONGO, GINA (MSN FNP)
Entity Type:Individual
Prefix:
First Name:GINA
Middle Name:
Last Name:LONGO
Suffix:
Gender:F
Credentials:MSN FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 CENTER POINTE DR
Mailing Address - Street 2:SUITE 1
Mailing Address - City:CLARKSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37040-8424
Mailing Address - Country:US
Mailing Address - Phone:931-648-7615
Mailing Address - Fax:931-648-7616
Practice Address - Street 1:111 CENTER POINTE DR
Practice Address - Street 2:SUITE 1
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37040-8424
Practice Address - Country:US
Practice Address - Phone:931-648-7615
Practice Address - Fax:931-648-7616
Is Sole Proprietor?:No
Enumeration Date:2009-08-04
Last Update Date:2009-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNF0709120363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily