Organization Active NPI

Old City Professional Services LLC

  • Obstetrics & Gynecology Physician
  • Saint Augustine, FL
National Provider Identifier
1386434512
Registry record updated May 9, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Obstetrics & Gynecology PhysicianTaxonomy code 207V00000X
Legal business name
OLD CITY PROFESSIONAL SERVICES LLC
Practice address
2225 A1A S Ste B4
Saint Augustine, FL 32080-7906
Phone
(904) 870-1860
Fax
(904) 404-9677
NPI assigned
May 9, 2025
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 9, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Nangela Pulsfus
Title
Practice Owner
Phone
(904) 870-1860

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Obstetrics & Gynecology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207V00000X Primary

Addresses

Primary practice location

2225 A1A S Ste B4
Saint Augustine, FL 32080-7906

Mailing address

314 Marsh Point Cir
Saint Augustine, FL 32080-5857
Phone (904) 870-1860

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20250904001831 FL Part B Supplier - Clinic/Group Practice 2062914633 Receives reassigned benefits from 1 practitioner
Practice locations: Saint Augustine, FL

National Provider Directory

National Provider Directory

Locations

2225 A1A S
Ste B4
Saint Augustine, FL 32080
Phone (904) 870-1860

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1746748800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1746748800000",
    "number": "1386434512",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "314 MARSH POINT CIR",
            "city": "SAINT AUGUSTINE",
            "state": "FL",
            "postal_code": "320805857",
            "telephone_number": "904-870-1860",
            "fax_number": "904-404-9677"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2225 A1A S STE B4",
            "city": "SAINT AUGUSTINE",
            "state": "FL",
            "postal_code": "320807906",
            "telephone_number": "904-870-1860",
            "fax_number": "904-404-9677"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OLD CITY PROFESSIONAL SERVICES LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-05-09",
        "last_updated": "2025-05-09",
        "certification_date": "2025-05-09",
        "status": "A",
        "authorized_official_last_name": "PULSFUS",
        "authorized_official_first_name": "NANGELA",
        "authorized_official_title_or_position": "PRACTICE OWNER",
        "authorized_official_telephone_number": "904-870-1860"
    },
    "taxonomies": [
        {
            "code": "207V00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Obstetrics & Gynecology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Saint Augustine, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 9, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.