Provider Demographics
NPI:1689676405
Name:WEEKS-LONG, JANIE M (CRNA)
Entity Type:Individual
Prefix:
First Name:JANIE
Middle Name:M
Last Name:WEEKS-LONG
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:862 THE MASTERS BLVD
Mailing Address - Street 2:
Mailing Address - City:SHALIMAR
Mailing Address - State:FL
Mailing Address - Zip Code:32579-1664
Mailing Address - Country:US
Mailing Address - Phone:850-651-6984
Mailing Address - Fax:
Practice Address - Street 1:862 THE MASTERS BLVD
Practice Address - Street 2:
Practice Address - City:SHALIMAR
Practice Address - State:FL
Practice Address - Zip Code:32579-1664
Practice Address - Country:US
Practice Address - Phone:850-651-6984
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-11
Last Update Date:2020-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2299249367500000X
FL1281222367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110106610AMedicaid