Provider Demographics
NPI:1134896376
Name:LONGA, ANISLEY (APRN)
Entity type:Individual
Prefix:
First Name:ANISLEY
Middle Name:
Last Name:LONGA
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9000 NW 15TH ST UNIT 6
Mailing Address - Street 2:
Mailing Address - City:DORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33172-2990
Mailing Address - Country:US
Mailing Address - Phone:786-894-6358
Mailing Address - Fax:
Practice Address - Street 1:1565 W 29TH ST
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33012-5516
Practice Address - Country:US
Practice Address - Phone:305-537-4110
Practice Address - Fax:305-675-2860
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-25
Last Update Date:2024-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9498576163WH0200X, 163WG0000X, 163WC1500X
FLAPRN11023555363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
No163WH0200XNursing Service ProvidersRegistered NurseHome Health
No163WG0000XNursing Service ProvidersRegistered NurseGeneral PracticeGroup - Multi-Specialty
No163WC1500XNursing Service ProvidersRegistered NurseCommunity Health