Active NPI
Marianne Illustre
- Physician Assistant
- Peoria, AZ
National Provider Identifier
1679445738
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- 2788
- Practice address
- 14300 N 83Rd Ave Apt 2013
Peoria, AZ 85381-5606 - Phone
- (516) 725-7481
- NPI assigned
- Sep 19, 2025
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 2788 | PR | Primary |
Addresses
Primary practice location
14300 N 83Rd Ave Apt 2013
Peoria, AZ 85381-5606
Mailing address
14300 N 83Rd Ave Apt 2013
Peoria, AZ 85381-5606
Phone (516) 725-7481
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2788 | PR | MD | Student in an Organized Health Care Education/Training Program |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1758240000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1758240000000",
"number": "1679445738",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "14300 N 83RD AVE APT 2013",
"city": "PEORIA",
"state": "AZ",
"postal_code": "853815606",
"telephone_number": "516-725-7481"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "14300 N 83RD AVE APT 2013",
"city": "PEORIA",
"state": "AZ",
"postal_code": "853815606",
"telephone_number": "516-725-7481"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ILLUSTRE",
"first_name": "MARIANNE",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2025-09-19",
"last_updated": "2025-09-19",
"certification_date": "2025-09-18",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Physician Assistant",
"state": "PR",
"license": "2788",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Peoria, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 19, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.