Provider Demographics
NPI:1528535283
Name:LONGSTRETH, BLAKE ERRAN (APRN)
Entity type:Individual
Prefix:
First Name:BLAKE
Middle Name:ERRAN
Last Name:LONGSTRETH
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3821 FAITHWAY DR
Mailing Address - Street 2:
Mailing Address - City:MURFREESBORO
Mailing Address - State:TN
Mailing Address - Zip Code:37128-5547
Mailing Address - Country:US
Mailing Address - Phone:615-714-1620
Mailing Address - Fax:
Practice Address - Street 1:5400 MARYLAND WAY STE 100
Practice Address - Street 2:
Practice Address - City:BRENTWOOD
Practice Address - State:TN
Practice Address - Zip Code:37027-1005
Practice Address - Country:US
Practice Address - Phone:615-661-5698
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-30
Last Update Date:2018-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN24818363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily