Provider Demographics
NPI:1144074428
Name:LONGO, SOPHIE (FNP-BC)
Entity type:Individual
Prefix:
First Name:SOPHIE
Middle Name:
Last Name:LONGO
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8904 CASTLETON LN
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27615-3900
Mailing Address - Country:US
Mailing Address - Phone:815-212-0833
Mailing Address - Fax:
Practice Address - Street 1:1415 W NC HIGHWAY 54 BLDG 300
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27707-5577
Practice Address - Country:US
Practice Address - Phone:919-578-2323
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-15
Last Update Date:2025-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5021428363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily