Provider Demographics
NPI:1063058667
Name:JERROLDS, ABBY ELIZABETH (NP)
Entity type:Individual
Prefix:
First Name:ABBY
Middle Name:ELIZABETH
Last Name:JERROLDS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:ABBY
Other - Middle Name:ELIZABETH
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:PO BOX 655
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:TN
Mailing Address - Zip Code:38372-0655
Mailing Address - Country:US
Mailing Address - Phone:731-925-2300
Mailing Address - Fax:731-925-2157
Practice Address - Street 1:175 ENOCH BLVD
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:TN
Practice Address - Zip Code:38372-2240
Practice Address - Country:US
Practice Address - Phone:731-925-2300
Practice Address - Fax:731-925-2157
Is Sole Proprietor?:No
Enumeration Date:2019-11-19
Last Update Date:2021-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN26684363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics