TINA JOLLY MSN APRN NP-C NPI 1619412004

NPI Information

NPI: 1619412004
Provider Name: TINA JOLLY, MSN, APRN, NP-C
Classification: Nurse Practitioner - 363LF0000X
Entity Type: Individual

Specialization: Family

PECOS Registration: Yes

Address:
165 BLUE RIDGE OVERLOOK
BLUE RIDGE, GA
ZIP 30513
Phone: (706) 946-4647
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Tina Jolly, MSN, APRN, NP-C is a family nurse practitioner in Blue Ridge, GA with 8 years of experience. Tina Jolly, MSN, APRN, NP-C NPI is 1619412004. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a female.

The provider's business location address is:

165 BLUE RIDGE OVERLOOK
BLUE RIDGE, GA
ZIP 30513-431
Phone: (706) 946-4647
Fax: (706) 374-5006

The NPI 1619412004 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA), Power Mobility Devices.

The enumeration date for this NPI number is 12/21/2016 and was last updated on 9/8/2022.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	363LF0000X	Nurse Practitioner	Family	RN139653	GEORGIA	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State
1	1619412004	MEDICAID	NORTH CAROLINA
2	Q071116	MEDICAID	TENNESSEE
3	003151473D	MEDICAID	GEORGIA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

NPI Synchronization or Removal

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