Active NPI
Laura Deree Long, MS, AGPCNP
- Registered Nurse
- Eden Prairie, MN
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Nurse
- License
- 9340365
- 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
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 11
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| 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
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| 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
| License | State | Type | Specialty |
|---|---|---|---|
| 9340365 | FL | MD | Registered Nurse |
| AG0117105 | FL | MD | Adult Health Nurse Practitioner |
| 0106659 | CO | MD | Gerontology Nurse Practitioner |
| H190805 | IA | MD | Gerontology Nurse Practitioner |
| 2026021232 | MO | MD | Gerontology Nurse Practitioner |
| 5024497 | NC | MD | Gerontology Nurse Practitioner |
| 228742 | OK | MD | Gerontology Nurse Practitioner |
| 31994 | SC | MD | Gerontology Nurse Practitioner |
| 70131278 | WA | MD | Gerontology Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Wellmed Medical Management of Florida Inc | Current | Accepting new patients | |
| Nautilus Health Care Group, LLC | Undersea and Hyperbaric Medicine | Current | Accepting new patients |
| Nautilus Health Care Group LLC | Undersea and Hyperbaric Medicine | Current | 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
- 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.
-
- Undersea and Hyperbaric Medicine (Preventive Medicine) Physician
- Melbourne, FL
- NPI 1912013558
-
- Undersea and Hyperbaric Medicine (Preventive Medicine) Physician
- Kokomo, IN
- NPI 1013234699
-
- Family Medicine Physician
- Port St Lucie, FL
- NPI 1033395397
-
- Durable Medical Equipment & Medical Supplies
- St Petersburg, FL
- NPI 1508054271
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
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 14, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.