| NPI | 1841747722 |
|---|---|
| Former Name | TINA ANN LONG |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: TN 4590) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MD C06212) |
| Enumeration Date | 2016-09-08 |
| Last Update Date | 2021-08-17 |