Healthcare Provider Details

I. General information

NPI: 1760587174
Provider Name (Legal Business Name): JENNA JOLLY NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/13/2006
Last Update Date: 07/02/2026
Certification Date: 07/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1109 GRANBY RD
CHICOPEE MA
01020-1568
US

IV. Provider business mailing address

332 BIRNIE AVE
SPRINGFIELD MA
01107-1106
US

V. Phone/Fax

Practice location:
  • Phone: 413-683-0159
  • Fax:
Mailing address:
  • Phone: 844-243-4357
  • Fax: 413-451-0037

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number251899
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number251899
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: