Provider Demographics
NPI:1063713824
Name:PEASE, MARQUIS (PA)
Entity type:Individual
Prefix:
First Name:MARQUIS
Middle Name:
Last Name:PEASE
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:MARQUIS
Other - Middle Name:TAYS
Other - Last Name:SIMMS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PA
Mailing Address - Street 1:4371 VERONICA S SHOEMAKER BLVD
Mailing Address - Street 2:ATTN: CREDENTIALING DEPT
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33916-2216
Mailing Address - Country:US
Mailing Address - Phone:239-274-8200
Mailing Address - Fax:
Practice Address - Street 1:15681 NEW HAMPSHIRE CT
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33908-4123
Practice Address - Country:US
Practice Address - Phone:239-437-4444
Practice Address - Fax:239-437-5788
Is Sole Proprietor?:No
Enumeration Date:2010-11-10
Last Update Date:2016-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9105740363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical