Healthcare Provider Details

I. General information

NPI: 1043661994
Provider Name (Legal Business Name): LITTLE PINE PEDIATRICS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/22/2016
Last Update Date: 03/03/2021
Certification Date: 03/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15551 NW US HIGHWAY 441 UNIT 40
ALACHUA FL
32615-9330
US

IV. Provider business mailing address

1702 S JEFFERSON ST
PERRY FL
32348-5611
US

V. Phone/Fax

Practice location:
  • Phone: 386-518-0102
  • Fax: 386-518-0116
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberOS9746
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. RONALD EMERICK JR.
Title or Position: OWNER
Credential: D.O.
Phone: 855-577-5437