Provider Demographics
NPI:1932413747
Name:LONG, TERRESA ANN (NP)
Entity Type:Individual
Prefix:
First Name:TERRESA
Middle Name:ANN
Last Name:LONG
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:TERRESA
Other - Middle Name:A
Other - Last Name:LONG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 2123
Mailing Address - Street 2:
Mailing Address - City:BRYSON CITY
Mailing Address - State:NC
Mailing Address - Zip Code:28713-5123
Mailing Address - Country:US
Mailing Address - Phone:910-490-0490
Mailing Address - Fax:828-538-4441
Practice Address - Street 1:710 SUNSET BLVD N STE A
Practice Address - Street 2:
Practice Address - City:SUNSET BEACH
Practice Address - State:NC
Practice Address - Zip Code:28468-4340
Practice Address - Country:US
Practice Address - Phone:910-663-2273
Practice Address - Fax:910-663-4050
Is Sole Proprietor?:No
Enumeration Date:2010-08-04
Last Update Date:2023-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5004840363L00000X
NC84565363LF0000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCNC9163I564OtherMEDICARE
NC17438OtherBCBS NC
XL2218370OtherUS DOJ
NC5004840OtherFNP LIC