Individual
JENORA H JOLLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
3190 N SWAN RD, TUCSON, AZ 85712-1227
(520) 547-9700
(520) 547-9717
Mailing address
5055 E BROADWAY BLVD, A-100, TUCSON, AZ 85711-3640
(520) 327-0460
(520) 795-0225
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
44155
AZ
207RG0300X
Geriatric Medicine (Internal Medicine) Physician
44155
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
587584
AHCCCS
AZ
01
—
Z143258
MEDICARE PTAN
AZ
Enumeration date
01/25/2007
Last updated
02/10/2012
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