Provider Demographics
NPI:1093050478
Name:MARQUES, JAMIE (ARNP)
Entity Type:Individual
Prefix:MR
First Name:JAMIE
Middle Name:
Last Name:MARQUES
Suffix:
Gender:M
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 CANYON STONE CIR
Mailing Address - Street 2:
Mailing Address - City:LAKE MARY
Mailing Address - State:FL
Mailing Address - Zip Code:32746-3973
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:725 RODEL CV
Practice Address - Street 2:
Practice Address - City:LAKE MARY
Practice Address - State:FL
Practice Address - Zip Code:32746-4859
Practice Address - Country:US
Practice Address - Phone:407-977-4130
Practice Address - Fax:407-977-4139
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-11
Last Update Date:2014-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9185439363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL007736000Medicaid
GX223ZMedicare PIN