Provider Demographics
NPI:1487084927
Name:LONG, ROBIN (CPNP)
Entity type:Individual
Prefix:MRS
First Name:ROBIN
Middle Name:
Last Name:LONG
Suffix:
Gender:F
Credentials:CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11408 STONEWALL JACKSON DR
Mailing Address - Street 2:
Mailing Address - City:SPOTSYLVANIA
Mailing Address - State:VA
Mailing Address - Zip Code:22551-4607
Mailing Address - Country:US
Mailing Address - Phone:540-412-5440
Mailing Address - Fax:
Practice Address - Street 1:23164 DRAGOON RD
Practice Address - Street 2:
Practice Address - City:LIGNUM
Practice Address - State:VA
Practice Address - Zip Code:22726-2036
Practice Address - Country:US
Practice Address - Phone:540-399-5066
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-11-20
Last Update Date:2013-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024171016363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics