Healthcare Provider Details

I. General information

NPI: 1912190497
Provider Name (Legal Business Name): ANDREA SUPLICK ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/20/2007
Last Update Date: 07/10/2025
Certification Date: 07/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2125 BISCAYNE BLVD
MIAMI FL
33137-5031
US

IV. Provider business mailing address

274 MADISON AVE RM 1501
NEW YORK NY
10016-0701
US

V. Phone/Fax

Practice location:
  • Phone: 212-203-1773
  • Fax: 646-665-4427
Mailing address:
  • Phone: 212-203-1773
  • Fax: 646-665-4427

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number403804
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberARNP3272682
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: