Provider Demographics
NPI:1225600075
Name:JOLY, ANA (RT)
Entity Type:Individual
Prefix:
First Name:ANA
Middle Name:
Last Name:JOLY
Suffix:
Gender:F
Credentials:RT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:356 CHANDLER ST
Mailing Address - Street 2:
Mailing Address - City:CAPE CANAVERAL
Mailing Address - State:FL
Mailing Address - Zip Code:32920-2138
Mailing Address - Country:US
Mailing Address - Phone:321-591-0632
Mailing Address - Fax:
Practice Address - Street 1:1990 W NEW HAVEN AVE STE 105
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32904-3908
Practice Address - Country:US
Practice Address - Phone:321-768-6119
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-12
Last Update Date:2021-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLTT87992278P1005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2278P1005XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, CertifiedPulmonary Rehabilitation