MEDICARE: MRS. MICHELLE LITTLE CARTER CRTT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	227800000X	Certified Respiratory Therapist	TT2624	FL

General Provider Information

NPI Number	:	1730603002
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MICHELLE LITTLE CARTER CRTT

Provider Business Mailing Address
First Line	:	6851 DISTRIBUTION AVE S
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32256
Country	:	US
Telephone Number	:	904-387-4481
Fax Number	:	904-389-6965

Provider Business Practice Location Address
First Line	:	6851 DISTRIBUTION AVE S
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32256-2742
Country	:	US
Telephone Number	:	904-387-4481
Fax Number	:	904-389-6965

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/28/2017
Last Update Date	:	07/28/2017

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