Individual
JOLLY THOMAS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP-C
Contact information
Practice address
3115 W BAJADA DR, PHOENIX, AZ 85083-5822
(480) 619-7856
Mailing address
3115 W BAJADA DR, PHOENIX, AZ 85083-5822
(480) 619-7856
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
281739
AZ
Other
Enumeration date
10/04/2022
Last updated
10/04/2022
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