Provider Demographics
NPI:1053766519
Name:LONG, CHRISTINA (NP)
Entity type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:
Last Name:LONG
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 408
Mailing Address - Street 2:
Mailing Address - City:WARTBURG
Mailing Address - State:TN
Mailing Address - Zip Code:37887-0408
Mailing Address - Country:US
Mailing Address - Phone:423-346-6221
Mailing Address - Fax:423-346-5565
Practice Address - Street 1:224 OLD MILL RD
Practice Address - Street 2:
Practice Address - City:WARTBURG
Practice Address - State:TN
Practice Address - Zip Code:37887-4163
Practice Address - Country:US
Practice Address - Phone:423-346-6221
Practice Address - Fax:423-346-5565
Is Sole Proprietor?:No
Enumeration Date:2016-05-03
Last Update Date:2016-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN21153363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner