Individual provider Active NPI

Laura Deree Long, MS, AGPCNP

  • Registered Nurse
  • Eden Prairie, MN
National Provider Identifier
1881130870
Registry record updated Jul 14, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Registered NurseTaxonomy code 163W00000X
License
9340365 Issued in FL
Practice address
11000 Optum Cir
Eden Prairie, MN 55344-2503
Phone
(888) 608-1777
Fax
(877) 329-4130
NPI assigned
Jan 13, 2017
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 14, 2026

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

Specialties & licenses 11

Specialty (taxonomy)CodeLicenseStatePrimary
Gerontology Nurse Practitioner 363LG0600X 70131278 WA
Gerontology Nurse Practitioner 363LG0600X 31994 SC
Gerontology Nurse Practitioner 363LG0600X 0106659 CO
Primary Care Nurse Practitioner 363LP2300X AG0117105 FL
Gerontology Nurse Practitioner 363LG0600X 228742 OK
Adult Health Nurse Practitioner 363LA2200X AG0117105 FL
Gerontology Nurse Practitioner 363LG0600X AG0117105 FL
Registered Nurse 163W00000X 9340365 FL Primary
Gerontology Nurse Practitioner 363LG0600X 2026021232 MO
Gerontology Nurse Practitioner 363LG0600X 5024497 NC
Gerontology Nurse Practitioner 363LG0600X H190805 IA

Addresses

Primary practice location

11000 Optum Cir
Eden Prairie, MN 55344-2503

Mailing address

11000 Optum Cir
Eden Prairie, MN 55344-2503
Phone (888) 608-1777

Other practice location 1

13655 Riverport Dr
Maryland Heights, MO 63043-4812
Phone (888) 608-1777

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20260618001931 IA Order and Referring Only - Nurse Practitioner 1658618996

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Master of Science, Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
9340365FLMDRegistered Nurse
AG0117105FLMDAdult Health Nurse Practitioner
0106659COMDGerontology Nurse Practitioner
H190805IAMDGerontology Nurse Practitioner
2026021232MOMDGerontology Nurse Practitioner
5024497NCMDGerontology Nurse Practitioner
228742OKMDGerontology Nurse Practitioner
31994SCMDGerontology Nurse Practitioner
70131278WAMDGerontology Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Wellmed Medical Management of Florida Inc CurrentSince May 1, 2023 Accepting new patients
Nautilus Health Care Group, LLC Undersea and Hyperbaric Medicine CurrentSince Apr 1, 2020 Accepting new patients
Nautilus Health Care Group LLC Undersea and Hyperbaric Medicine CurrentSince Apr 1, 2020 Accepting new patients
Advanced Wound Systems LLC Past Accepting new patients

Locations

5220 Belfort Rd
Ste 130
Jacksonville, FL 32256
Phone (904) 446-3686

2155 SE Federal Hwy
Stuart, FL 34994
Phone (772) 223-9630

1120 Pinellas Bayway S
Ste 200
Tierra Verde, FL 33715
Phone (727) 867-5480

200 Avenue F NE
Winter Haven, FL 33881
Phone (863) 292-4652

8637 Fredericksburg Rd
Ste 360
San Antonio, TX 78240
Phone (210) 304-3500

Interoperability endpoints

  • Direct secure messaging: laura.long@wellmed.eclinicaldirectplus.com

Organizations & group practices 4

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": "1484265600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1783987200000",
    "number": "1881130870",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11000 OPTUM CIR",
            "city": "EDEN PRAIRIE",
            "state": "MN",
            "postal_code": "553442503",
            "telephone_number": "888-608-1777",
            "fax_number": "877-329-4130"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11000 OPTUM CIR",
            "city": "EDEN PRAIRIE",
            "state": "MN",
            "postal_code": "553442503",
            "telephone_number": "888-608-1777",
            "fax_number": "877-329-4130"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "13655 Riverport Dr",
            "address_purpose": "LOCATION",
            "city": "Maryland Heights",
            "state": "MO",
            "postal_code": "630434812",
            "country_code": "US",
            "telephone_number": "888-608-1777",
            "fax_number": "877-329-4130",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "LONG",
        "first_name": "LAURA",
        "middle_name": "DEREE",
        "credential": "MS, AGPCNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-01-13",
        "last_updated": "2026-07-14",
        "certification_date": "2026-07-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LG0600X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Gerontology",
            "state": "WA",
            "license": "70131278",
            "primary": false
        },
        {
            "code": "363LG0600X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Gerontology",
            "state": "SC",
            "license": "31994",
            "primary": false
        },
        {
            "code": "363LG0600X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Gerontology",
            "state": "CO",
            "license": "0106659",
            "primary": false
        },
        {
            "code": "363LP2300X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Primary Care",
            "state": "FL",
            "license": "AG0117105",
            "primary": false
        },
        {
            "code": "363LG0600X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Gerontology",
            "state": "OK",
            "license": "228742",
            "primary": false
        },
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "FL",
            "license": "AG0117105",
            "primary": false
        },
        {
            "code": "363LG0600X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Gerontology",
            "state": "FL",
            "license": "AG0117105",
            "primary": false
        },
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "FL",
            "license": "9340365",
            "primary": true
        },
        {
            "code": "363LG0600X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Gerontology",
            "state": "MO",
            "license": "2026021232",
            "primary": false
        },
        {
            "code": "363LG0600X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Gerontology",
            "state": "NC",
            "license": "5024497",
            "primary": false
        },
        {
            "code": "363LG0600X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Gerontology",
            "state": "IA",
            "license": "H190805",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Eden Prairie, MN

Sources for this page

Verify at the official NPI Registry.