Provider Demographics
NPI:1679245914
Name:LONG, JESSICA RENEE (APRN)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:RENEE
Last Name:LONG
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 55009
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32216-0009
Mailing Address - Country:US
Mailing Address - Phone:904-398-5614
Mailing Address - Fax:904-398-5617
Practice Address - Street 1:2122 UNIVERSITY BLVD S
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32216-8937
Practice Address - Country:US
Practice Address - Phone:904-398-5614
Practice Address - Fax:904-398-5617
Is Sole Proprietor?:No
Enumeration Date:2021-10-05
Last Update Date:2021-10-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FL11008692363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner