Healthcare Provider Details

I. General information

NPI: 1134504079
Provider Name (Legal Business Name): LARRY ROBERT LITTLE APRN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/21/2015
Last Update Date: 02/18/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

YOUR HEALTH OF FL, LLC 1301 PLANTATION ISLAND DR. UNITE 303B
ST. AUGUSTINE FL
32080
US

IV. Provider business mailing address

SC HOUSE CALLS INC. 111 DOCTORS CIR.
COLUMBIA SC
29203
US

V. Phone/Fax

Practice location:
  • Phone: 800-491-0909
  • Fax:
Mailing address:
  • Phone: 800-491-0909
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License NumberARNP 9169328
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License NumberAPRN9169328
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: