Provider Demographics
NPI:1588116008
Name:PUGMIRE, REBECCA SAMPLES (FNP-C)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:SAMPLES
Last Name:PUGMIRE
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:REBECCA
Other - Middle Name:DIANE
Other - Last Name:SAMPLES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:600 GRESHAM DR STE 8620
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23507-1904
Mailing Address - Country:US
Mailing Address - Phone:757-395-1600
Mailing Address - Fax:757-625-0433
Practice Address - Street 1:600 GRESHAM DR STE 8620
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23507-1904
Practice Address - Country:US
Practice Address - Phone:757-395-1600
Practice Address - Fax:757-625-0433
Is Sole Proprietor?:No
Enumeration Date:2016-11-01
Last Update Date:2023-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024174130363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily