Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Marissa Bournique

Individual provider Internal Medicine Physician · NPI 1417332131

Marissa Bournique is a Gastroenterology in Port St Lucie, Florida. Graduated from Lake Erie College of Osteopathic Medicine, Bradenton in 2015, 11 years ago. Practices with Tallahassee Memorial Healthcare Inc, a 497-clinician group and accepts Medicare assignment. Licensed in Florida.

Years since qualifying
11
Trained at
Lake Erie College of Osteopathic Medicine, Bradenton
Licensed in
FL
In the registry since
2015
Specialties on file
2
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Practice location Address checks out

1700 SE Hillmoor Dr
Port St Lucie, FL 34952-7539
Phone: (772) 335-9600
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Gastroenterology Physician (primary) Taxonomy 207RG0100X · Licence OS15441 (FL)
Internal Medicine Physician Taxonomy 207R00000X · Licence UO4447 (FL)

Record details

NPI number1417332131
Entity typeIndividual (Type 1)
GenderFemale
Sole proprietorYes
NPI enumeratedJuly 23, 2015
Last updated in NPPESApril 8, 2021
Certification dateApril 8, 2021
Mailing address1700 Se Hillmoor Dr, Port St Lucie, FL 34952-7539

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyGASTROENTEROLOGY
Medical schoolLAKE ERIE COLLEGE OF OSTEOPATHIC MEDICINE, BRADENTON
Graduated 2015 (11 years in practice)
Group practice Tallahassee Memorial Healthcare Inc — 497 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations2 on file with Medicare

Other providers in Port St Lucie