Provider Demographics
NPI:1316182462
Name:JOSE, JOLLY (NP-C)
Entity Type:Individual
Prefix:
First Name:JOLLY
Middle Name:
Last Name:JOSE
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1948 E HEBRON PKWY
Mailing Address - Street 2:SUITE 110
Mailing Address - City:CARROLLTON
Mailing Address - State:TX
Mailing Address - Zip Code:75007-1525
Mailing Address - Country:US
Mailing Address - Phone:972-939-4646
Mailing Address - Fax:972-939-6161
Practice Address - Street 1:1948 E HEBRON PKWY
Practice Address - Street 2:SUITE 110
Practice Address - City:CARROLLTON
Practice Address - State:TX
Practice Address - Zip Code:75007-1525
Practice Address - Country:US
Practice Address - Phone:972-939-4646
Practice Address - Fax:972-939-6161
Is Sole Proprietor?:No
Enumeration Date:2008-12-03
Last Update Date:2011-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX714041363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily