Mike Maurice Supplice, ARNP

Primary specialty

Critical Care Medicine (Anesthesiology) PhysicianTaxonomy code 207LC0200X

License

RN210166 Issued in GA

Practice address

2009 Miccosukee Rd
Tallahassee, FL 32308-5359

Phone

(850) 942-2299

Fax

(850) 942-0322

NPI assigned

Sep 16, 2013

Last updated

Nov 10, 2022By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in FL, GA2 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

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

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

• Paragon Emergency Services LLC

  • Emergency Medicine Physician
  • Winter Haven, FL
  • NPI 1912101650

  Nurse Practitioner

  Medicare reassignment NPD
• Emory Medical Care Foundation Inc

  • Internal Medicine Physician
  • Atlanta, GA
  • NPI 1063452381

  Nurse Practitioner

  Medicare reassignment NPD
• Wellstar Medical Group, LLC

  dba WellStar Family Medicine ACW

  • Family Medicine Physician
  • Kennesaw, GA
  • NPI 1558664003
  Medicare reassignment NPD
• Deerfield Beach Physician Services, LLC

  • Internal Medicine Physician
  • Tallahassee, FL
  • NPI 1366100364
  Medicare reassignment
• Emory Medical Care Foundation Inc

  • Diagnostic Radiology Physician
  • Atlanta, GA
  • NPI 1225294739
  NPD
• Wellstar Medical Group, LLC

  • Multi-Specialty Clinic/Center
  • Marietta, GA
  • NPI 1275992240
  NPD
• CDR Health Care Inc

  • Family Medicine Physician
  • Tallahassee, FL
  • NPI 1497352587
  NPD (past)
• CDR Laboratories Inc

  • Clinical Medical Laboratory
  • Doral, FL
  • NPI 1730820846
  NPD (past)
• Acworth Outpatient Detox, LLC

  • Substance Use Disorder Rehabilitation Clinic/Center
  • Acworth, GA
  • NPI 1497327720
  NPD (past)

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

{
    "created_epoch": "1379289600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1668038400000",
    "number": "1689000101",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2009 MICCOSUKEE RD",
            "city": "TALLAHASSEE",
            "state": "FL",
            "postal_code": "323085359",
            "telephone_number": "850-942-2299",
            "fax_number": "850-942-0322"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2009 MICCOSUKEE RD",
            "city": "TALLAHASSEE",
            "state": "FL",
            "postal_code": "323085359",
            "telephone_number": "850-942-2299",
            "fax_number": "850-942-0322"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SUPPLICE",
        "first_name": "MIKE",
        "middle_name": "MAURICE",
        "name_prefix": "Mr.",
        "credential": "ARNP",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2013-09-16",
        "last_updated": "2022-11-10",
        "certification_date": "2022-11-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "FL",
            "license": "ARNP9290091",
            "primary": false
        },
        {
            "code": "207LC0200X",
            "taxonomy_group": "",
            "desc": "Anesthesiology, Critical Care Medicine",
            "state": "GA",
            "license": "RN210166",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Kristine Sutherland, MSN, CPNP-PC

• Critical Care Medicine (Anesthesiology) Physician in Tallahassee, FL
• Providers in Tallahassee, FL by specialty
• Critical Care Medicine (Anesthesiology) Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 10, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.