Most Relevant Information
Provider Data
| NPI Number: | 1003541673 |
| Provider Name: | NICOLE ELIZABETH LONGO FNP |
| Entity Type: | Individual |
| Taxonomy Code: | 363LF0000X |
| Specialty: | Nurse Practitioner |
| License Number: | 5019188 |
Most Important Dates
| Enumeration Date: | 07/19/2022 |
| Last Updated: | 07/15/2024 |
Provider Practice Location
1090 NE GATEWAY CT NE
STE 202
CONCORD
NC
280252414
Practice Location Phone/Fax
| Phone: | 7044039050 |
| Fax: |
Provider Mailing Location
PO BOX 19305
CHARLOTTE
NC
282199305
Provider Mailing Phone/Fax
| Phone: | |
| Fax: |