Provider Demographics
NPI:1710993142
Name:LONG, GAYE LENORE (RN RNFA)
Entity Type:Individual
Prefix:MS
First Name:GAYE
Middle Name:LENORE
Last Name:LONG
Suffix:
Gender:F
Credentials:RN RNFA
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:2117 SHUMARD LANE
Mailing Address - Street 2:
Mailing Address - City:SHUMARD LANE
Mailing Address - State:TX
Mailing Address - Zip Code:75028
Mailing Address - Country:US
Mailing Address - Phone:972-355-8777
Mailing Address - Fax:
Practice Address - Street 1:1350 S HICKORY ST
Practice Address - Street 2:HEALTH FIRST HOLMO REGIONAL MEDICAL CENTER
Practice Address - City:MELMOURNE
Practice Address - State:FL
Practice Address - Zip Code:32701
Practice Address - Country:US
Practice Address - Phone:321-434-7000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN2760332163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse