Individual
MR. ALBERT-MARY LONGCHAMP
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
14502 N DALE MABRY HWY STE 200, TAMPA, FL 33618-2040
(800) 640-3451
Mailing address
811 DATELAND RD SE, PALM BAY, FL 32909-6681
(954) 547-9618
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
11018757
FL
363L00000X
Nurse Practitioner
Primary
11018757
FL
363LA2200X
Adult Health Nurse Practitioner
11018757
FL
Other
Enumeration date
04/12/2022
Last updated
02/13/2024
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