Mary K Long, PA

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PA0003154 Issued in FL

Practice address

2627 Riverside Ave Ste 300
Jacksonville, FL 32204-4717

Phone

(904) 634-0640

Fax

(904) 634-0203

NPI assigned

Oct 4, 2006

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other names 1

• Mary K Falbo Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

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.

• Emergency Physicians of St. Johns County

  • Emergency Medicine Physician
  • St Augustine, FL
  • NPI 1801881818
  NPD (past)
• Southeast Orthopedic Specialists, LLC

  • Orthopaedic Surgery Physician
  • Jacksonville, FL
  • NPI 1629025820
  NPD (past)
• St Luke'S Emergency Care Group LLC

  • Emergency Medicine Physician
  • Jacksonville, FL
  • NPI 1871762013
  NPD (past)

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

{
    "created_epoch": "1159920000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1603324800000",
    "number": "1497840326",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6500 BOWDEN RD STE 103",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322168066",
            "telephone_number": "904-634-0640",
            "fax_number": "904-634-0203"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2627 RIVERSIDE AVE STE 300",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322044717",
            "telephone_number": "904-634-0640",
            "fax_number": "904-634-0203"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LONG",
        "first_name": "MARY",
        "middle_name": "K",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-10-04",
        "last_updated": "2020-10-22",
        "certification_date": "2020-10-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "FL",
            "license": "PA0003154",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MARY",
            "last_name": "FALBO",
            "middle_name": "K",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Jessica Renee Long, APRN
• John Earl Long, MD
• Kevin R. Long, A.R.N.P.
• Lindsay M Long
• Marisa Elaine Long, PA-C
• Padrika L Long, RN,BSN
• Ralph Long Jr., PHARMD
• Ryan R Long, DDS
• Steven Dwight Long III, PT
• Tafana A Long

• Physician Assistant in Jacksonville, FL
• Providers in Jacksonville, FL by specialty
• Physician Assistant in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 22, 2020; 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.