Individual
GINOU SUPRE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
23240 FITZPATRICK AVE, PUNTA GORDA, FL 33980-5730
(239) 601-2058
Mailing address
23240 FITZPATRICK AVE, PUNTA GORDA, FL 33980-5730
(239) 601-2058
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
RN9550663
FL
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
RN9550663
FL
Other
Enumeration date
12/10/2025
Last updated
12/10/2025
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