Provider Demographics
NPI:1518575000
Name:LONG, REBECCA CHRISTINE (MSN, APRN, FNP-BC)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:CHRISTINE
Last Name:LONG
Suffix:
Gender:F
Credentials:MSN, APRN, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3377 NW 26TH AVE
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33434-3419
Mailing Address - Country:US
Mailing Address - Phone:239-821-4154
Mailing Address - Fax:
Practice Address - Street 1:3377 NW 26TH AVE
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33434-3419
Practice Address - Country:US
Practice Address - Phone:239-821-4154
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-21
Last Update Date:2020-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11007997363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily