Provider Demographics
NPI:1841710670
Name:SHOUPPE, KATIE LOU (MSN,ARNP-FNP)
Entity type:Individual
Prefix:
First Name:KATIE
Middle Name:LOU
Last Name:SHOUPPE
Suffix:
Gender:F
Credentials:MSN,ARNP-FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1341 MEDICAL PARK DR STE 201
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32901-3235
Mailing Address - Country:US
Mailing Address - Phone:321-768-9914
Mailing Address - Fax:321-768-0033
Practice Address - Street 1:436 AIRPORT RD STE 20
Practice Address - Street 2:
Practice Address - City:ARDEN
Practice Address - State:NC
Practice Address - Zip Code:28704-8403
Practice Address - Country:US
Practice Address - Phone:407-200-2352
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-22
Last Update Date:2024-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5015728207Q00000X, 363LF0000X
FLARNP9350266363L00000X
FLAPRN9350266363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPENDINGOtherMEDICARE