Provider Demographics
NPI:1093044265
Name:SUPERVILLE, GERALDINE (ARNP)
Entity Type:Individual
Prefix:
First Name:GERALDINE
Middle Name:
Last Name:SUPERVILLE
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4960 SW 72ND AVE
Mailing Address - Street 2:SUITE 406
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33155-5544
Mailing Address - Country:US
Mailing Address - Phone:305-662-5200
Mailing Address - Fax:305-284-7948
Practice Address - Street 1:4960 SW 72ND AVE
Practice Address - Street 2:SUITE 406
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33155-5544
Practice Address - Country:US
Practice Address - Phone:305-662-5200
Practice Address - Fax:305-284-7948
Is Sole Proprietor?:No
Enumeration Date:2009-12-16
Last Update Date:2009-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP3209202363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner