Provider Demographics
NPI:1083653869
Name:LONG, DIANE PAIGE (APRN)
Entity type:Individual
Prefix:
First Name:DIANE
Middle Name:PAIGE
Last Name:LONG
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:DIANE
Other - Middle Name:PAIGE
Other - Last Name:KRASNOPERO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN
Mailing Address - Street 1:601 5TH ST S
Mailing Address - Street 2:CARDIOLOGY
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33701-4804
Mailing Address - Country:US
Mailing Address - Phone:727-767-4954
Mailing Address - Fax:727-767-2880
Practice Address - Street 1:1405 CLIFTON RD NE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30322-4634
Practice Address - Country:US
Practice Address - Phone:404-785-6395
Practice Address - Fax:404-785-1994
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2024-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF381443363LP0200X
FLARNP 9246874363LP0200X
GARN280201363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02202371Medicaid
NY02202371Medicaid
NY02202371Medicaid