Provider Demographics
NPI:1417254236
Name:LONG, VANESSA ROXANE (MSN, APRN-CNP)
Entity type:Individual
Prefix:
First Name:VANESSA
Middle Name:ROXANE
Last Name:LONG
Suffix:
Gender:F
Credentials:MSN, APRN-CNP
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Other - First Name:
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Mailing Address - Street 1:14201 W SUNRISE BLVD STE 208
Mailing Address - Street 2:
Mailing Address - City:SUNRISE
Mailing Address - State:FL
Mailing Address - Zip Code:33323-3207
Mailing Address - Country:US
Mailing Address - Phone:405-251-7338
Mailing Address - Fax:405-444-3965
Practice Address - Street 1:3261 24TH AVE NW STE 101
Practice Address - Street 2:
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73069-6666
Practice Address - Country:US
Practice Address - Phone:405-251-7338
Practice Address - Fax:405-444-3965
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-14
Last Update Date:2024-06-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OKROO89357363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLEW721AMedicare Oscar/Certification