Provider Demographics
NPI:1174566392
Name:LITTLE, MARTIN L (PA-C)
Entity type:Individual
Prefix:
First Name:MARTIN
Middle Name:L
Last Name:LITTLE
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9909 SAN SEBASTIAN WAY
Mailing Address - Street 2:
Mailing Address - City:PORT RICHEY
Mailing Address - State:FL
Mailing Address - Zip Code:34668-3554
Mailing Address - Country:US
Mailing Address - Phone:727-842-3626
Mailing Address - Fax:
Practice Address - Street 1:5637 MARINE PKWY
Practice Address - Street 2:
Practice Address - City:NEW PORT RICHEY
Practice Address - State:FL
Practice Address - Zip Code:34652-4316
Practice Address - Country:US
Practice Address - Phone:727-845-9115
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2010-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9102061363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
P30548Medicare UPIN