Provider Demographics
NPI:1750399549
Name:PUGLIA, JACQUELYN ESTHER (MD)
Entity type:Individual
Prefix:DR
First Name:JACQUELYN
Middle Name:ESTHER
Last Name:PUGLIA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1516 ISLAND GREEN DR
Mailing Address - Street 2:
Mailing Address - City:MIRAMAR BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32550-5878
Mailing Address - Country:US
Mailing Address - Phone:850-687-9713
Mailing Address - Fax:850-424-5579
Practice Address - Street 1:1516 ISLAND GREEN DR
Practice Address - Street 2:
Practice Address - City:MIRAMAR BEACH
Practice Address - State:FL
Practice Address - Zip Code:32550-5878
Practice Address - Country:US
Practice Address - Phone:850-687-9713
Practice Address - Fax:850-424-5579
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-04
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME55553207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLBP1953391OtherDEA