Individual
TRAVIS DAVID LONG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
2565 ENTERPRISE RD STE 400, ORANGE CITY, FL 32763-8016
(321) 841-6444
(321) 842-1955
Mailing address
2565 ENTERPRISE RD STE 400, ORANGE CITY, FL 32763-8016
(321) 841-6444
(321) 842-1955
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
PA9107114
FL
363AM0700X
Medical Physician Assistant
Primary
PA9107114
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003135044A
—
GA
05
—
0089009-00
—
FL
05
—
008900900
—
FL
01
—
Y0HL0
BLUE CROSS BLUE SHIELD
FL
Enumeration date
05/22/2013
Last updated
05/12/2026
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