Provider Demographics
NPI:1790839991
Name:TSURGEON, MARIE ANTOINETTE (PA-C)
Entity Type:Individual
Prefix:
First Name:MARIE
Middle Name:ANTOINETTE
Last Name:TSURGEON
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:MARIE
Other - Middle Name:ANTOINETTE
Other - Last Name:POLYCARPE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:225 176TH ST S
Mailing Address - Street 2:
Mailing Address - City:SPANAWAY
Mailing Address - State:WA
Mailing Address - Zip Code:98387-9201
Mailing Address - Country:US
Mailing Address - Phone:253-459-7777
Mailing Address - Fax:
Practice Address - Street 1:225 176TH ST S
Practice Address - Street 2:
Practice Address - City:SPANAWAY
Practice Address - State:WA
Practice Address - Zip Code:98387-9201
Practice Address - Country:US
Practice Address - Phone:253-459-7777
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-23
Last Update Date:2015-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004112-1363A00000X
WAPA10004312363A00000X, 363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant