Provider Demographics
NPI:1831679869
Name:POLLAN, JARETT LAWRENCE (FNP)
Entity Type:Individual
Prefix:MR
First Name:JARETT
Middle Name:LAWRENCE
Last Name:POLLAN
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 490
Mailing Address - Street 2:
Mailing Address - City:MCCOMB
Mailing Address - State:MS
Mailing Address - Zip Code:39649-0490
Mailing Address - Country:US
Mailing Address - Phone:601-249-2701
Mailing Address - Fax:601-249-2195
Practice Address - Street 1:1311 ASTON AVE
Practice Address - Street 2:
Practice Address - City:MCCOMB
Practice Address - State:MS
Practice Address - Zip Code:39648-2825
Practice Address - Country:US
Practice Address - Phone:601-684-2481
Practice Address - Fax:601-684-2488
Is Sole Proprietor?:No
Enumeration Date:2018-08-20
Last Update Date:2021-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS902695363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS08534301Medicaid