Provider Demographics
NPI:1780320770
Name:LONG, BRITTANY (FNP-BC)
Entity type:Individual
Prefix:
First Name:BRITTANY
Middle Name:
Last Name:LONG
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:333 WHITESPORT DR SW STE 103
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35801-3455
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:12205 COUNTY LINE RD STE B
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:AL
Practice Address - Zip Code:35758-7720
Practice Address - Country:US
Practice Address - Phone:256-325-6722
Practice Address - Fax:256-325-6724
Is Sole Proprietor?:No
Enumeration Date:2022-05-11
Last Update Date:2023-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-127056363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner