Provider Demographics
NPI:1144867656
Name:JOLLY, TURQUOISE MICHELLE
Entity type:Individual
Prefix:MISS
First Name:TURQUOISE
Middle Name:MICHELLE
Last Name:JOLLY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2558
Mailing Address - Street 2:
Mailing Address - City:STUART
Mailing Address - State:FL
Mailing Address - Zip Code:34995-2558
Mailing Address - Country:US
Mailing Address - Phone:904-206-1651
Mailing Address - Fax:
Practice Address - Street 1:1908 SE WALTON LAKES DR
Practice Address - Street 2:
Practice Address - City:PORT SAINT LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34952-5110
Practice Address - Country:US
Practice Address - Phone:904-206-1651
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-03
Last Update Date:2019-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)