Provider Demographics
NPI:1245424829
Name:LITTLE, JENNA MARIE (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:JENNA
Middle Name:MARIE
Last Name:LITTLE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MISS
Other - First Name:JENNA
Other - Middle Name:MARIE
Other - Last Name:JONES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:1300 HORIZON DR
Mailing Address - Street 2:STE 101
Mailing Address - City:CHALFONT
Mailing Address - State:PA
Mailing Address - Zip Code:18914-3970
Mailing Address - Country:US
Mailing Address - Phone:215-489-9170
Mailing Address - Fax:215-489-9174
Practice Address - Street 1:500 CHASE PKWY
Practice Address - Street 2:SUITE 2B
Practice Address - City:WATERBURY
Practice Address - State:CT
Practice Address - Zip Code:06708-3346
Practice Address - Country:US
Practice Address - Phone:203-755-6677
Practice Address - Fax:203-755-7166
Is Sole Proprietor?:No
Enumeration Date:2007-08-28
Last Update Date:2017-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH50.002600363AS0400X, 363A00000X
CT003290363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT003290OtherCONNECTICUT LICENSE
CT003290OtherCONNECTICUT LICENSE