Healthcare Provider Details

I. General information

NPI: 1366554107
Provider Name (Legal Business Name): MARIE PRINSEN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 04/11/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 WELLNESS WAY SUITE 109
SEBASTIAN FL
32958-3783
US

IV. Provider business mailing address

1000 36TH ST
VERO BEACH FL
32960-4862
US

V. Phone/Fax

Practice location:
  • Phone: 772-581-5581
  • Fax: 772-563-4723
Mailing address:
  • Phone: 772-567-4311
  • Fax: 772-563-4723

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberME110076
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: