Healthcare Provider Details

I. General information

NPI: 1477146173
Provider Name (Legal Business Name): AGNES KAREN LITTLE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/15/2021
Last Update Date: 02/15/2021
Certification Date: 02/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1503 S LOCUST AVE
SANFORD FL
32771-2957
US

IV. Provider business mailing address

1002 CYPRESS AVE
SANFORD FL
32771-2664
US

V. Phone/Fax

Practice location:
  • Phone: 407-314-7067
  • Fax:
Mailing address:
  • Phone: 407-314-7067
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2278P1005X
TaxonomyPulmonary Rehabilitation Certified Respiratory Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: