Provider Demographics
NPI:1689000101
Name:SUPPLICE, MIKE MAURICE (ARNP)
Entity Type:Individual
Prefix:MR
First Name:MIKE
Middle Name:MAURICE
Last Name:SUPPLICE
Suffix:
Gender:M
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2009 MICCOSUKEE RD
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32308-5359
Mailing Address - Country:US
Mailing Address - Phone:850-942-2299
Mailing Address - Fax:850-942-0322
Practice Address - Street 1:2009 MICCOSUKEE RD
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32308-5359
Practice Address - Country:US
Practice Address - Phone:850-942-2299
Practice Address - Fax:850-942-0322
Is Sole Proprietor?:No
Enumeration Date:2013-09-16
Last Update Date:2022-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9290091363L00000X
GARN210166207LC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LC0200XAllopathic & Osteopathic PhysiciansAnesthesiologyCritical Care Medicine
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner