Healthcare Provider Details

I. General information

NPI: 1437864998
Provider Name (Legal Business Name): AMANDA NINA LITTLE FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/19/2023
Last Update Date: 01/19/2023
Certification Date: 01/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

33 S SECOND AVE
MC RAE GA
31055-4658
US

IV. Provider business mailing address

33 S SECOND AVE
MC RAE GA
31055-4658
US

V. Phone/Fax

Practice location:
  • Phone: 229-868-2020
  • Fax: 478-374-1478
Mailing address:
  • Phone: 229-868-2020
  • Fax: 478-374-1478

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN224819
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: