Healthcare Provider Details

I. General information

NPI: 1760872766
Provider Name (Legal Business Name): TAMARA LITTLE CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/28/2015
Last Update Date: 05/22/2023
Certification Date: 05/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 KINGSLEY LN STE 200
NORFOLK VA
23505-4604
US

IV. Provider business mailing address

100 KINGSLEY LN STE 200
NORFOLK VA
23505-4604
US

V. Phone/Fax

Practice location:
  • Phone: 757-451-0929
  • Fax: 757-423-4901
Mailing address:
  • Phone: 704-177-0839
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License NumberNURU1501
License Number StateAK
# 2
Primary TaxonomyN
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License NumberAP138085
License Number StateTX
# 3
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number24184277
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: