MEDICARE: SUPREME COMPREHENSIVE HEALTH SERVICES, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner
2	363LP0808X	Psychiatric/Mental Health Nurse Practitioner

General Provider Information

NPI Number	:	1760371405
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SUPREME COMPREHENSIVE HEALTH SERVICES, LLC

Provider Business Mailing Address
First Line	:	PO BOX 90014
Second Line	:
City	:	LAKELAND
State	:	FL
Zip	:	33804-0014
Country	:	US
Telephone Number	:	443-980-2011
Fax Number	:

Provider Business Practice Location Address
First Line	:	2404 LAKELAND HILLS BLVD
Second Line	:
City	:	LAKELAND
State	:	FL
Zip	:	33805-2214
Country	:	US
Telephone Number	:	443-980-2011
Fax Number	:

Authorized Official
Title or Position	:	FNP-BC/PMHNP-BC
Name	:	DR. EVA UGONNA OKEREKE-ENECHUKWU
Credential	:	DNP, APRN
Telephone Number	:	443-980-2011

Provider Enumeration Date	:	06/30/2025
Last Update Date	:	07/18/2025

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