Individual
JACKSON SANGUILY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
413 29TH ST NE STE I, PUYALLUP, WA 98372-7154
(855) 255-1750
(855) 255-0905
Mailing address
PO BOX 24081, SEATTLE, WA 98124-0081
(855) 255-1750
(855) 255-0905
Taxonomy
Speciality
Code
Description
License number
State
146N00000X
Basic Emergency Medical Technician
Q212354
CO
363A00000X
Physician Assistant
Primary
PA.PA.70147889
WA
363AM0700X
Medical Physician Assistant
PA.PA.70147889
WA
363AS0400X
Surgical Physician Assistant
PA.PA.70147889
WA
Other
Enumeration date
05/21/2024
Last updated
07/06/2026
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