Active NPI
Jenna Pucilowski
- Gerontology Nurse Practitioner
- Seattle, WA
National Provider Identifier
1265056923
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Gerontology Nurse Practitioner
- License
- 61272478
- Practice address
- 1959 NE Pacific St
Seattle, WA 98195-0001 - Phone
- (206) 543-8736
- NPI assigned
- May 29, 2020
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Gerontology Nurse Practitioner | 363LG0600X | 61272478 | WA | Primary |
| Registered Nurse | 163W00000X | RN60282717 | WA |
Addresses
Primary practice location
1959 NE Pacific St
Seattle, WA 98195-0001
Mailing address
1959 NE Pacific St
Seattle, WA 98195-7263
Phone (206) 543-8736
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 |
|---|---|---|---|
| RN60282717 | WA | MD | Registered Nurse |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1590710400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1784678400000",
"number": "1265056923",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1959 NE PACIFIC ST",
"city": "SEATTLE",
"state": "WA",
"postal_code": "981957263",
"telephone_number": "206-543-8736"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1959 NE PACIFIC ST",
"city": "SEATTLE",
"state": "WA",
"postal_code": "981950001",
"telephone_number": "206-543-8736"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PUCILOWSKI",
"first_name": "JENNA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2020-05-29",
"last_updated": "2026-07-22",
"certification_date": "2026-07-22",
"status": "A"
},
"taxonomies": [
{
"code": "363LG0600X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Gerontology",
"state": "WA",
"license": "61272478",
"primary": true
},
{
"code": "163W00000X",
"taxonomy_group": "",
"desc": "Registered Nurse",
"state": "WA",
"license": "RN60282717",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Seattle, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 22, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.