Provider Demographics
NPI:1760536791
Name:LONG, DONNA F (CRNA)
Entity Type:Individual
Prefix:
First Name:DONNA
Middle Name:F
Last Name: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 1:4739 TIERRA ALTA CT
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33813-2362
Mailing Address - Country:US
Mailing Address - Phone:402-676-7132
Mailing Address - Fax:
Practice Address - Street 1:4739 TIERRA ALTA CT
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33813-2362
Practice Address - Country:US
Practice Address - Phone:402-676-7132
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-23
Last Update Date:2013-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE100352367500000X
FLARNP 9272551367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE0138802Medicare ID - Type Unspecified