Provider Demographics
NPI:1134156318
Name:LONG, ELIZABETH M (APRN-C)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:M
Last Name:LONG
Suffix:
Gender:F
Credentials:APRN-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:7945 GLENEAGLES DR
Mailing Address - Street 2:
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77707-5466
Mailing Address - Country:US
Mailing Address - Phone:409-840-4999
Mailing Address - Fax:409-983-5146
Practice Address - Street 1:755 N 11TH ST
Practice Address - Street 2:SUITE P-5200
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77702-1500
Practice Address - Country:US
Practice Address - Phone:409-898-2994
Practice Address - Fax:409-983-5146
Is Sole Proprietor?:No
Enumeration Date:2006-06-26
Last Update Date:2017-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX537565363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX183748601Medicaid
TX537565OtherAPRN-C LICENSE #
TX183746001OtherMEDICAID GROUP
TX537565OtherAPRN-C LICENSE #
TX8F4114Medicare PIN