Provider Demographics
NPI:1396170361
Name:JOLLY, BRANDIE ROMANDIA (NP)
Entity type:Individual
Prefix:
First Name:BRANDIE
Middle Name:ROMANDIA
Last Name:JOLLY
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:100 CAPITOL COMMERCE BLVD
Mailing Address - Street 2:SUITE 250
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36117-4260
Mailing Address - Country:US
Mailing Address - Phone:334-386-1432
Mailing Address - Fax:334-386-1479
Practice Address - Street 1:7065 SYDNEY CURV
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36117-3509
Practice Address - Country:US
Practice Address - Phone:334-323-4000
Practice Address - Fax:334-386-1479
Is Sole Proprietor?:No
Enumeration Date:2013-09-10
Last Update Date:2013-09-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AL1-125063363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily