Provider Demographics
NPI:1831185313
Name:LITTLE, DIANE CAMPBELL (ARNP)
Entity type:Individual
Prefix:
First Name:DIANE
Middle Name:CAMPBELL
Last Name:LITTLE
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3686 US HIGHWAY 331 S
Mailing Address - Street 2:
Mailing Address - City:DEFUNIAK SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32435-8463
Mailing Address - Country:US
Mailing Address - Phone:850-892-8045
Mailing Address - Fax:850-892-8039
Practice Address - Street 1:3686 US HIGHWAY 331 S
Practice Address - Street 2:
Practice Address - City:DEFUNIAK SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32435-8463
Practice Address - Country:US
Practice Address - Phone:850-892-8045
Practice Address - Fax:850-892-8039
Is Sole Proprietor?:No
Enumeration Date:2005-09-21
Last Update Date:2011-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNPRN839422163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLY9808OtherBCBS
FL761912000Medicaid
P28946Medicare UPIN
FLY9808OtherBCBS