Provider Demographics
NPI:1255722021
Name:LONG, VICTORIA (NP)
Entity type:Individual
Prefix:MS
First Name:VICTORIA
Middle Name:
Last Name:LONG
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4185 TECHNOLOGY FOREST BLVD STE 210
Mailing Address - Street 2:
Mailing Address - City:THE WOODLANDS
Mailing Address - State:TX
Mailing Address - Zip Code:77381-2005
Mailing Address - Country:US
Mailing Address - Phone:936-447-9483
Mailing Address - Fax:936-447-9410
Practice Address - Street 1:4185 TECHNOLOGY FOREST BLVD STE 210
Practice Address - Street 2:
Practice Address - City:THE WOODLANDS
Practice Address - State:TX
Practice Address - Zip Code:77381-2005
Practice Address - Country:US
Practice Address - Phone:936-447-9483
Practice Address - Fax:936-447-9410
Is Sole Proprietor?:No
Enumeration Date:2015-02-13
Last Update Date:2023-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP127464363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily