Provider Demographics
NPI:1669689121
Name:TARA LITTLEJOHN GONZALES MD - ARBOR PEDIATRICS
Entity Type:Organization
Organization Name:TARA LITTLEJOHN GONZALES MD - ARBOR PEDIATRICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:DR
Authorized Official - First Name:TARA
Authorized Official - Middle Name:LITTLEJOHN
Authorized Official - Last Name:GONZALES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:850-477-5475
Mailing Address - Street 1:7530 TREASURE ST
Mailing Address - Street 2:
Mailing Address - City:NAVARRE
Mailing Address - State:FL
Mailing Address - Zip Code:32566-7875
Mailing Address - Country:US
Mailing Address - Phone:850-936-8083
Mailing Address - Fax:850-936-8083
Practice Address - Street 1:4220 N DAVIS HWY # A-200
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32503-2752
Practice Address - Country:US
Practice Address - Phone:850-477-5475
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLANT3306292261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care