Basic Information
| Provider Information | |||||||||
| NPI: | 1669440731 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MARQUIS | ||||||||
| FirstName: | MARY | ||||||||
| MiddleName: | E. | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | ARNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3142 VISTA WAY | ||||||||
| Address2: | #206 HEALTHLINK MEDICAL CENTER | ||||||||
| City: | OCEANSIDE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 92056 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7607214000 | ||||||||
| FaxNumber: | 7607214005 | ||||||||
| Practice Location | |||||||||
| Address1: | 3142 VISTA WAY | ||||||||
| Address2: | #206 HEALTHLINK MEDICAL CENTER | ||||||||
| City: | OCEANSIDE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 92056 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7607214000 | ||||||||
| FaxNumber: | 7607214005 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/14/2006 | ||||||||
| LastUpdateDate: | 05/10/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | ARNP1823482 | FL | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | 363LA2200X | 18267 | CA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Adult Health | 363LA2200X | 311650 | CA | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Adult Health | 363LA2200X | 1823482 | FL | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Adult Health | 363LA2200X | 0102117 | FL | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Adult Health |
ID Information
| ID | Type | State | Issuer | Description | 651003929 | 01 | FL | TAX ID | OTHER |