Provider Demographics
NPI:1548425945
Name:LITTLES, CARRIE MAE
Entity type:Individual
Prefix:MS
First Name:CARRIE
Middle Name:MAE
Last Name:LITTLES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2901 NE 17TH TER
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32609-3249
Mailing Address - Country:US
Mailing Address - Phone:352-376-3768
Mailing Address - Fax:352-376-9043
Practice Address - Street 1:2901 NE 17TH TER
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32609-3249
Practice Address - Country:US
Practice Address - Phone:352-376-3768
Practice Address - Fax:352-376-9043
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-24
Last Update Date:2008-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL686045196172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker