Individual provider Active NPI

Michael Anthony Parks, ARNP

  • Family Nurse Practitioner
  • Cape Coral, FL
National Provider Identifier
1144719246
Registry record updated Oct 7, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
ARNP9359158 Issued in FL
Practice address
2441 Surfside Blvd Ste 200
Cape Coral, FL 33914
Phone
(239) 541-7500
Fax
(239) 541-7501
NPI assigned
May 3, 2018
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Oct 7, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X ARNP9359158 FL Primary

Addresses

Primary practice location

2441 Surfside Blvd Ste 200
Cape Coral, FL 33914

Mailing address

PO Box 2147
Fort Myers, FL 33902-2147
Phone (239) 541-7500

Other identifiers 1

IdentifierTypeStateIssuer
024819400MedicaidFL

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI, TX2 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20200930001109 MI Practitioner - Nurse Practitioner 2264787068 Reassigns benefits to 1 organization
I20220428001107 TX Practitioner - Nurse Practitioner 2264787068 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
ARNP9359158FLMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Theoria Medical CurrentSince Sep 1, 2020 Accepting new patients

Locations

5655 Clarkston Rd
Clarkston, MI 48348
Phone (810) 623-5216

901 Pinecreek Dr
Fenton, MI 48430
Phone (810) 616-4100

3139 E Baldwin Rd
Grand Blanc, MI 48439
Phone (810) 445-5300

41800 W 11 Mile Rd
Ste 109
Novi, MI 48375
Phone (833) 578-2763

310 S Jupiter Rd
Allen, TX 75002
Phone (972) 437-0250

3737 N Garland Ave
Garland, TX 75040
Phone (214) 315-6310

2712 Hurstview Dr
Hurst, TX 76054
Phone (817) 281-6407

Interoperability endpoints

  • Direct secure messaging: mparks1056519@direct.hfhs.org

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1525305600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1602028800000",
    "number": "1144719246",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2147",
            "city": "FORT MYERS",
            "state": "FL",
            "postal_code": "339022147",
            "telephone_number": "239-541-7500",
            "fax_number": "239-541-7501"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2441 SURFSIDE BLVD STE 200",
            "city": "CAPE CORAL",
            "state": "FL",
            "postal_code": "33914",
            "telephone_number": "239-541-7500",
            "fax_number": "239-541-7501"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PARKS",
        "first_name": "MICHAEL",
        "middle_name": "ANTHONY",
        "credential": "ARNP",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2018-05-03",
        "last_updated": "2020-10-07",
        "certification_date": "2020-10-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "FL",
            "license": "ARNP9359158",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "024819400",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Cape Coral, FL

Sources for this page

Verify at the official NPI Registry.