MEDICARE: MS. CLENETTE SURPRIS ARNP, FNP-BC

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	207R00000X	Internal Medicine Physician	APRN11019501	FL
2	363LP2300X	Primary Care Nurse Practitioner	APRN11019501	FL
3	363LF0000X	Family Nurse Practitioner	APRN11019501	FL

General Provider Information

NPI Number	:	1902542194
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. CLENETTE SURPRIS ARNP, FNP-BC

Provider Business Mailing Address
First Line	:	8403 PINES BLVD # 1324
Second Line	:
City	:	PEMBROKE PINES
State	:	FL
Zip	:	33024-6609
Country	:	US
Telephone Number	:	954-551-4400
Fax Number	:

Provider Business Practice Location Address
First Line	:	8403 PINES BLVD # 1324
Second Line	:
City	:	PEMBROKE PINES
State	:	FL
Zip	:	33024-6609
Country	:	US
Telephone Number	:	954-551-4400
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/10/2022
Last Update Date	:	01/07/2025

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