Healthcare Provider Details

I. General information

NPI: 1396170361
Provider Name (Legal Business Name): BRANDIE ROMANDIA JOLLY NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/10/2013
Last Update Date: 09/10/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7065 SYDNEY CURV
MONTGOMERY AL
36117-3509
US

IV. Provider business mailing address

100 CAPITOL COMMERCE BLVD SUITE 250
MONTGOMERY AL
36117-4260
US

V. Phone/Fax

Practice location:
  • Phone: 334-323-4000
  • Fax: 334-386-1479
Mailing address:
  • Phone: 334-386-1432
  • Fax: 334-386-1479

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1-125063
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: