Provider Demographics
NPI:1114017498
Name:PUGLISI, JANIS PANZENHAGEN (PHD, APRN, FNP-BC)
Entity type:Individual
Prefix:
First Name:JANIS
Middle Name:PANZENHAGEN
Last Name:PUGLISI
Suffix:
Gender:F
Credentials:PHD, APRN, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 746724
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-6724
Mailing Address - Country:US
Mailing Address - Phone:773-644-3941
Mailing Address - Fax:
Practice Address - Street 1:2850 S MAIN ST STE 104
Practice Address - Street 2:
Practice Address - City:HIGH POINT
Practice Address - State:NC
Practice Address - Zip Code:27263-1900
Practice Address - Country:US
Practice Address - Phone:336-200-7003
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-15
Last Update Date:2024-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC201506NP363LP2300X
NC141960RN363LP2300X
NC201506363L00000X, 363LF0000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC141960OtherRN
NC201506OtherNURSE PRACTITIONER
NC201506OtherNURSE PRACTITIONER