Provider Demographics
NPI:1477273514
Name:JONES, JODIE (RN)
Entity type:Individual
Prefix:
First Name:JODIE
Middle Name:
Last Name:JONES
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:JODIE
Other - Middle Name:
Other - Last Name:BOLIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPN, RN
Mailing Address - Street 1:1049 ROQUEMORE DR
Mailing Address - Street 2:
Mailing Address - City:ORANGEBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29115-8936
Mailing Address - Country:US
Mailing Address - Phone:803-216-5150
Mailing Address - Fax:
Practice Address - Street 1:1049 ROQUEMORE DR
Practice Address - Street 2:
Practice Address - City:ORANGEBURG
Practice Address - State:SC
Practice Address - Zip Code:29115-8936
Practice Address - Country:US
Practice Address - Phone:803-682-3570
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-30
Last Update Date:2024-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC216958163W00000X
SC28858363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse