Provider Demographics
NPI:1760872766
Name:LITTLE, TAMARA (CNM)
Entity Type:Individual
Prefix:
First Name:TAMARA
Middle Name:
Last Name:LITTLE
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 KINGSLEY LN STE 200
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23505-4604
Mailing Address - Country:US
Mailing Address - Phone:704-177-0839
Mailing Address - Fax:
Practice Address - Street 1:100 KINGSLEY LN STE 200
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23505-4604
Practice Address - Country:US
Practice Address - Phone:757-451-0929
Practice Address - Fax:757-423-4901
Is Sole Proprietor?:No
Enumeration Date:2015-01-28
Last Update Date:2023-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AKNURU1501367A00000X
TXAP138085367A00000X
VA24184277367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife