Provider Demographics
NPI:1982865218
Name:LONG, SARAH JEANETTE (CPNP)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:JEANETTE
Last Name:LONG
Suffix:
Gender:F
Credentials:CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8640 SUDLEY ROAD
Mailing Address - Street 2:SUITE 306
Mailing Address - City:MANASSAS
Mailing Address - State:VA
Mailing Address - Zip Code:20110-4404
Mailing Address - Country:US
Mailing Address - Phone:703-330-3939
Mailing Address - Fax:703-331-0959
Practice Address - Street 1:8640 SUDLEY ROAD
Practice Address - Street 2:SUITE 306
Practice Address - City:MANASSAS
Practice Address - State:VA
Practice Address - Zip Code:20110-4404
Practice Address - Country:US
Practice Address - Phone:703-330-3939
Practice Address - Fax:703-331-0959
Is Sole Proprietor?:No
Enumeration Date:2008-06-19
Last Update Date:2020-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024166266363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA02416626OtherVA LICENSE
VA1982865218Medicaid