Individual
EVONNE MARIE LONG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
AUD
Contact information
Practice address
1010 N DAVIS ST STE 101, JACKSONVILLE, FL 32209
(904) 355-3403
(904) 355-4149
Mailing address
1010 N DAVIS ST STE 101, JACKSONVILLE, FL 32209-6808
(904) 355-3403
(904) 355-4149
Taxonomy
Speciality
Code
Description
License number
State
231H00000X
Audiologist
7987
SC
231H00000X
Audiologist
Primary
AY1974
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
019346100
—
FL
01
—
AY1974
STATE LICENSING BOARD
FL
Enumeration date
09/22/2015
Last updated
10/18/2024
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