Provider Demographics
NPI:1083429948
Name:MIKE, JOHN EDWARD (DNP, APRN, FNP-C)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:EDWARD
Last Name:MIKE
Suffix:
Gender:M
Credentials:DNP, APRN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2541 W CAMDEN PL
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92704-4509
Mailing Address - Country:US
Mailing Address - Phone:651-500-0985
Mailing Address - Fax:
Practice Address - Street 1:2541 W CAMDEN PL
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92704-4509
Practice Address - Country:US
Practice Address - Phone:651-500-0985
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-10
Last Update Date:2025-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95030757363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily