Individual
JOHN LONG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
2000 E EDGEWOOD DR STE 112, LAKELAND, FL 33803-3639
(863) 666-3436
(863) 667-3550
Mailing address
2000 E EDGEWOOD DR STE 112, LAKELAND, FL 33803-3639
(863) 666-3436
(863) 667-3550
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
1218517
FL
Other
Enumeration date
12/18/2024
Last updated
03/05/2025
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