Individual
MS. CARLY LITTLE CONNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
807 CHILDRENS WAY, NEMOURS CHILDRENS CLINIC,, JACKSONVILLE, FL 32207-8426
(904) 697-3600
(904) 697-3927
Mailing address
7963 NORMANDY BLVD, PROVIDER ENROLLMENT DEPARTMENT, JACKSONVILLE, FL 32221-6640
(904) 786-0440
(904) 786-0485
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA9106018
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PA9106018
STATE OF FLORIDA DEPT. OF HEALTH
FL
Enumeration date
10/19/2011
Last updated
06/30/2016
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