Individual provider Active NPI

Cynthia Diane Long, FNP

  • Family Nurse Practitioner
  • Beaufort, SC
National Provider Identifier
1376776302
Registry record updated Jun 5, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
3848 Issued in SC
Practice address
335 Pleasant Point Dr
Beaufort, SC 29907-1164
Phone
(803) 699-9073
Fax
(866) 527-0937
NPI assigned
Aug 25, 2009
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 5, 2013

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X R34502 ND
Family Nurse Practitioner 363LF0000X 3848 SC Primary

Addresses

Primary practice location

335 Pleasant Point Dr
Beaufort, SC 29907-1164

Mailing address

PO Box 84068
Lexington, SC 29073-0002
Phone (803) 699-9073

Other identifiers 1

IdentifierTypeStateIssuer
NP2360MedicaidSC

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
3848SCMDGeriatric Pharmacist
R34502NDMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Rejuvenate Health Medical, LLC CurrentSince Jan 22, 2023 Accepting new patients
Senior Health Associates, PA PastSince Jan 21, 2014 Accepting new patients

Locations

53 Persimmon St
Ste 105
Bluffton, SC 29910
Phone (843) 757-7836

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1251158400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1370390400000",
    "number": "1376776302",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 84068",
            "city": "LEXINGTON",
            "state": "SC",
            "postal_code": "290730002",
            "telephone_number": "803-699-9073",
            "fax_number": "866-527-0937"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "335 PLEASANT POINT DR",
            "city": "BEAUFORT",
            "state": "SC",
            "postal_code": "299071164",
            "telephone_number": "803-699-9073",
            "fax_number": "866-527-0937"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LONG",
        "first_name": "CYNTHIA",
        "middle_name": "DIANE",
        "credential": "FNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-08-25",
        "last_updated": "2013-06-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "ND",
            "license": "R34502",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "SC",
            "license": "3848",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "NP2360",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Beaufort, SC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 5, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.