Provider Demographics
NPI:1386434512
Name:OLD CITY PROFESSIONAL SERVICES LLC
Entity type:Organization
Organization Name:OLD CITY PROFESSIONAL SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NANGELA
Authorized Official - Middle Name:
Authorized Official - Last Name:PULSFUS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-870-1860
Mailing Address - Street 1:314 MARSH POINT CIR
Mailing Address - Street 2:
Mailing Address - City:SAINT AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32080-5857
Mailing Address - Country:US
Mailing Address - Phone:904-870-1860
Mailing Address - Fax:904-404-9677
Practice Address - Street 1:2225 A1A S STE B4
Practice Address - Street 2:
Practice Address - City:SAINT AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32080-7906
Practice Address - Country:US
Practice Address - Phone:904-870-1860
Practice Address - Fax:904-404-9677
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-05-09
Last Update Date:2025-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty