Provider Demographics
NPI:1841866860
Name:LONG, DARNA KHAV (AGNP-C)
Entity type:Individual
Prefix:
First Name:DARNA
Middle Name:KHAV
Last Name:LONG
Suffix:
Gender:F
Credentials:AGNP-C
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:3800 S ALMA SCHOOL RD STE 112
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85248-4499
Mailing Address - Country:US
Mailing Address - Phone:602-406-3000
Mailing Address - Fax:916-636-4358
Practice Address - Street 1:350 W THOMAS RD
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85013-4409
Practice Address - Country:US
Practice Address - Phone:602-406-8302
Practice Address - Fax:602-406-7247
Is Sole Proprietor?:No
Enumeration Date:2021-06-01
Last Update Date:2024-08-30
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
AZAG06210004363L00000X
AZ258805363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner