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General NPI Number Information
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NPI Number | 1750735163
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Entity Type | Individual
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Provider Name | JACKIE OLLIS PMHNP-BC
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Gender | Female
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Dates
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Enumeration Date | 04/21/2016
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Last Update Date | 03/16/2023
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Provider Practice Location Address
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Address Line | 625 N PLAZA DR
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City | APACHE JUNCTION
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State | AZ
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Zip | 85120-5501
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Country | US
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Telephone | 480-474-5584
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Fax |
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Provider Business Mailing Address
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Address Line | 1351 N ALMA SCHOOL RD
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City | CHANDLER
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State | AZ
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Zip | 85224-5936
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Country | US
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Telephone | 480-814-7789
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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 | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | AP8521
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License Number State | AZ
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Taxonomy #2
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | RN197907
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License Number State | AZ
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