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NPI Code Detail

MEDICARE: MR. CHARLES A. JOLLEY III ACNP-BC

MEDICARE: MR. CHARLES A. JOLLEY III ACNP-BC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LA2100XAcute Care Nurse Practitioner15592TN

General Provider Information

NPI Number : 1568769834
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. CHARLES A. JOLLEY III ACNP-BC
Provider Business Mailing Address
First Line : 3841 GREEN HILLS VILLAGE DR STE 200
Second Line :
City : NASHVILLE
State : TN
Zip : 37215-2691
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 3601 THE VANDERBILT CLINIC
Second Line :
City : NASHVILLE
State : TN
Zip : 37232-0001
Country : US
Telephone Number : 615-322-5000
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/22/2011
Last Update Date : 01/15/2026

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