Provider Demographics
NPI:1629867817
Name:LONG, PADRIKA L (RN,BSN)
Entity type:Individual
Prefix:
First Name:PADRIKA
Middle Name:L
Last Name:LONG
Suffix:
Gender:F
Credentials:RN,BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10086 SITTING FOX DR
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32222-4180
Mailing Address - Country:US
Mailing Address - Phone:904-418-3216
Mailing Address - Fax:
Practice Address - Street 1:10086 SITTING FOX DR
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32222-4180
Practice Address - Country:US
Practice Address - Phone:904-418-3216
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-05
Last Update Date:2025-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)