Provider Demographics
NPI:1790066413
Name:LONGINOTTI, LISA GAIL (RNP)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:GAIL
Last Name:LONGINOTTI
Suffix:
Gender:F
Credentials:RNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8901 CARTI WAY
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72205-6523
Mailing Address - Country:US
Mailing Address - Phone:501-900-3000
Mailing Address - Fax:501-907-8367
Practice Address - Street 1:8901 CARTI WAY
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205-6523
Practice Address - Country:US
Practice Address - Phone:501-900-3000
Practice Address - Fax:501-907-8367
Is Sole Proprietor?:No
Enumeration Date:2011-09-08
Last Update Date:2018-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARP00845363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5X183Medicare PIN