Provider Demographics
NPI:1366554107
Name:PRINSEN, MARIE (MD)
Entity type:Individual
Prefix:DR
First Name:MARIE
Middle Name:
Last Name:PRINSEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 36TH ST
Mailing Address - Street 2:
Mailing Address - City:VERO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32960-4862
Mailing Address - Country:US
Mailing Address - Phone:772-567-4311
Mailing Address - Fax:772-563-4723
Practice Address - Street 1:801 WELLNESS WAY
Practice Address - Street 2:SUITE 109
Practice Address - City:SEBASTIAN
Practice Address - State:FL
Practice Address - Zip Code:32958-3783
Practice Address - Country:US
Practice Address - Phone:772-581-5581
Practice Address - Fax:772-563-4723
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2012-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME110076207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL003853000Medicaid
FL14F04OtherBCBS OF FL
FL003853000Medicaid