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General NPI Number Information
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NPI Number | 1336611995
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Entity Type | Individual
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Provider Name | REGINE JOLY RN, MPH, CHES, CCM,
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Gender | Female
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Dates
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Enumeration Date | 12/20/2018
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Last Update Date | 12/20/2018
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Provider Practice Location Address
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Address Line | 8895 SW 136TH ST
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City | MIAMI
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State | FL
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Zip | 33176-5816
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Country | US
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Telephone | 305-256-5480
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Fax |
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Provider Business Mailing Address
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Address Line | 17521 SW 93RD PL
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City | PALMETTO BAY
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State | FL
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Zip | 33157-5768
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Country | US
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Telephone | 305-256-5480
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163WC0400X
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Taxonomy Name | Case Management Registered Nurse
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License Number | RN2005292
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License Number State | FL
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