Active NPI
Jacob Charles Puglisi, PA-C
- Physician Assistant
- Fort Lee, VA
National Provider Identifier
1902867617
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- 0110003638
- Practice address
- 700 24TH St
Fort Lee, VA 23801-1716 - Phone
- (804) 734-9226
- NPI assigned
- Mar 31, 2006
- Sex
- Male
- 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 |
|---|---|---|---|---|
| Medical Physician Assistant | 363AM0700X | 0110003638 | VA | |
| Physician Assistant | 363A00000X | 0110003638 | VA | Primary |
Addresses
Primary practice location
700 24TH St
Fort Lee, VA 23801-1716
Mailing address
700 24TH St
Fort Lee, VA 23801-1716
Phone (804) 734-9226
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)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 0110003638 | VA | MD | Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1143763200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1735776000000",
"number": "1902867617",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "700 24TH ST",
"city": "FORT LEE",
"state": "VA",
"postal_code": "238011716",
"telephone_number": "804-734-9226"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "700 24TH ST",
"city": "FORT LEE",
"state": "VA",
"postal_code": "238011716",
"telephone_number": "804-734-9226"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PUGLISI",
"first_name": "JACOB",
"middle_name": "CHARLES",
"credential": "PA-C",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-03-31",
"last_updated": "2025-01-02",
"certification_date": "2025-01-02",
"status": "A"
},
"taxonomies": [
{
"code": "363AM0700X",
"taxonomy_group": "",
"desc": "Physician Assistant, Medical",
"state": "VA",
"license": "0110003638",
"primary": false
},
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "VA",
"license": "0110003638",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fort Lee, VA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 2, 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.