Individual
MARISA ELAINE LONG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
836 PRUDENTIAL DR STE 1001, JACKSONVILLE, FL 32207-8337
(904) 398-0033
(904) 398-6774
Mailing address
11945 SAN JOSE BLVD, STE 300, JACKSONVILLE, FL 32223-1627
(904) 396-1725
(904) 396-4893
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
PA9113569
FL
Other
Enumeration date
10/14/2020
Last updated
11/25/2020
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