Provider Demographics
NPI:1760820096
Name:JOLLY, JENNIFER C (APNP)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:C
Last Name:JOLLY
Suffix:
Gender:F
Credentials:APNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7402 ALDERSON ST
Mailing Address - Street 2:
Mailing Address - City:SCHOFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:54476-5013
Mailing Address - Country:US
Mailing Address - Phone:715-587-8838
Mailing Address - Fax:
Practice Address - Street 1:824 ILLINOIS AVE
Practice Address - Street 2:
Practice Address - City:STEVENS POINT
Practice Address - State:WI
Practice Address - Zip Code:54481-3112
Practice Address - Country:US
Practice Address - Phone:715-342-7775
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-09
Last Update Date:2018-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI174226-030163WC0400X
WI8310-33363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163WC0400XNursing Service ProvidersRegistered NurseCase Management