MEDICARE: KIM D JOLLY ARNP

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	363L00000X	Nurse Practitioner	ARNP2005522	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1831153733
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIM D JOLLY ARNP

Provider Business Mailing Address
First Line	:	1700 NW 49TH ST STE 125
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33309-3750
Country	:	US
Telephone Number	:	954-759-7557
Fax Number	:	954-733-9155

Provider Business Practice Location Address
First Line	:	3716 W OAKLAND PARK BLVD
Second Line	:
City	:	LAUDERDALE LAKES
State	:	FL
Zip	:	33311-1134
Country	:	US
Telephone Number	:	954-759-7557
Fax Number	:	954-733-9155

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

Provider Enumeration Date	:	04/17/2006
Last Update Date	:	04/01/2024

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Directions to “ KIM D JOLLY ARNP” Practice Location

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