Healthcare Provider Details

I. General information

NPI: 1053248765
Provider Name (Legal Business Name): PATRICIA JOLLY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/06/2026
Last Update Date: 05/06/2026
Certification Date: 05/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

444 HOBRON LN PH 1
HONOLULU HI
96815-1231
US

IV. Provider business mailing address

1925 KALAKAUA AVE APT 2603
HONOLULU HI
96815-1813
US

V. Phone/Fax

Practice location:
  • Phone: 808-862-8796
  • Fax:
Mailing address:
  • Phone: 812-322-3203
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number88615
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: