Healthcare Provider Details

I. General information

NPI: 1306701636
Provider Name (Legal Business Name): MS. JOANNE JOLIS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/18/2025
Last Update Date: 12/18/2025
Certification Date: 12/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16282 NW 17TH CT
PEMBROKE PINES FL
33028-1728
US

IV. Provider business mailing address

16282 NW 17TH CT
PEMBROKE PINES FL
33028-1728
US

V. Phone/Fax

Practice location:
  • Phone: 786-343-0634
  • Fax:
Mailing address:
  • Phone: 786-343-0634
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberF11250363
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: