MEDICARE: OLD CITY PROFESSIONAL SERVICES LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207V00000X	Obstetrics & Gynecology Physician

General Provider Information

NPI Number	:	1386434512
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OLD CITY PROFESSIONAL SERVICES LLC

Provider Business Mailing Address
First Line	:	314 MARSH POINT CIR
Second Line	:
City	:	SAINT AUGUSTINE
State	:	FL
Zip	:	32080-5857
Country	:	US
Telephone Number	:	904-870-1860
Fax Number	:	904-404-9677

Provider Business Practice Location Address
First Line	:	2225 A1A S STE B4
Second Line	:
City	:	SAINT AUGUSTINE
State	:	FL
Zip	:	32080-7906
Country	:	US
Telephone Number	:	904-870-1860
Fax Number	:	904-404-9677

Authorized Official
Title or Position	:	PRACTICE OWNER
Name	:	NANGELA PULSFUS
Credential	:
Telephone Number	:	904-870-1860

Provider Enumeration Date	:	05/09/2025
Last Update Date	:	05/09/2025

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Directions to “OLD CITY PROFESSIONAL SERVICES LLC ” Practice Location

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