Provider Demographics
NPI:1699000976
Name:JOLLY, YEN P (MS, NP-C)
Entity Type:Individual
Prefix:MRS
First Name:YEN
Middle Name:P
Last Name:JOLLY
Suffix:
Gender:F
Credentials:MS, NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:143 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MILPITAS
Mailing Address - State:CA
Mailing Address - Zip Code:95035-4322
Mailing Address - Country:US
Mailing Address - Phone:408-957-8300
Mailing Address - Fax:
Practice Address - Street 1:143 N MAIN ST
Practice Address - Street 2:
Practice Address - City:MILPITAS
Practice Address - State:CA
Practice Address - Zip Code:95035-4322
Practice Address - Country:US
Practice Address - Phone:408-957-8300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-10-05
Last Update Date:2012-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP 18855363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily