MEDICARE: MISS TURQUOISE MICHELLE JOLLY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	343900000X	Non-emergency Medical Transport (VAN)

General Provider Information

NPI Number	:	1144867656
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS TURQUOISE MICHELLE JOLLY

Provider Business Mailing Address
First Line	:	PO BOX 2558
Second Line	:
City	:	STUART
State	:	FL
Zip	:	34995-2558
Country	:	US
Telephone Number	:	904-206-1651
Fax Number	:

Provider Business Practice Location Address
First Line	:	1908 SE WALTON LAKES DR
Second Line	:
City	:	PORT SAINT LUCIE
State	:	FL
Zip	:	34952-5110
Country	:	US
Telephone Number	:	904-206-1651
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/03/2019
Last Update Date	:	12/03/2019

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Directions to “ MISS TURQUOISE MICHELLE JOLLY ” Practice Location

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