Provider Demographics
NPI:1134504079
Name:LITTLE, LARRY ROBERT (ARNP)
Entity Type:Individual
Prefix:MR
First Name:LARRY
Middle Name:ROBERT
Last Name:LITTLE
Suffix:
Gender:M
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:209 CACIQUE DR
Mailing Address - Street 2:
Mailing Address - City:SAINT AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32086-8828
Mailing Address - Country:US
Mailing Address - Phone:904-797-1805
Mailing Address - Fax:
Practice Address - Street 1:209 CACIQUE DR
Practice Address - Street 2:
Practice Address - City:SAINT AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32086-8828
Practice Address - Country:US
Practice Address - Phone:904-797-1805
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-21
Last Update Date:2015-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP 9169328363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care