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Individual

MARISSA BOURNIQUE

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F

Contact information

Practice address
1700 SE HILLMOOR DR, PORT ST LUCIE, FL 34952-7539
(772) 335-9600
Mailing address
1700 SE HILLMOOR DR, PORT ST LUCIE, FL 34952-7539
(772) 335-9600

Taxonomy

Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
UO4447
FL
207RG0100X
Gastroenterology Physician
Primary
OS15441
FL

Other

Enumeration date
07/23/2015
Last updated
04/08/2021
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