Provider Demographics
NPI:1194723528
Name:FURLONG, JOAN (CRNP)
Entity type:Individual
Prefix:
First Name:JOAN
Middle Name:
Last Name:FURLONG
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:JOAN
Other - Middle Name:
Other - Last Name:PETRLIK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN, CRNP
Mailing Address - Street 1:1589 SULPHUR SPRING RD
Mailing Address - Street 2:SUITE 109
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21227-2542
Mailing Address - Country:US
Mailing Address - Phone:410-536-5400
Mailing Address - Fax:410-737-2168
Practice Address - Street 1:808 LANDMARK DR
Practice Address - Street 2:SUITE 116
Practice Address - City:GLEN BURNIE
Practice Address - State:MD
Practice Address - Zip Code:21061-4983
Practice Address - Country:US
Practice Address - Phone:410-760-3588
Practice Address - Fax:410-760-3604
Is Sole Proprietor?:No
Enumeration Date:2005-07-11
Last Update Date:2007-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR030769363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDS58147Medicare UPIN
MDD348Medicare ID - Type Unspecified