Individual
TYLER JON LONG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
3614 KIESSEL RD, THE VILLAGES, FL 32163-2910
(352) 914-3451
Mailing address
3614 KIESSEL RD, THE VILLAGES, FL 32163-2910
(352) 914-3451
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
21531
FL
207N00000X
Dermatology Physician
25MB12236700
NJ
207ND0101X
MOHS-Micrographic Surgery Physician
21531
FL
207NS0135X
Procedural Dermatology Physician
21531
FL
208D00000X
General Practice Physician
0116034370
VA
Other
Enumeration date
04/21/2019
Last updated
07/16/2025
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