Provider Demographics
NPI:1598292229
Name:THOMAS JEFFERSON UNIVERSITY HOSPITAL
Entity Type:Organization
Organization Name:THOMAS JEFFERSON UNIVERSITY HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:MS
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:A
Authorized Official - Last Name:MOSS
Authorized Official - Suffix:
Authorized Official - Credentials:CRNP
Authorized Official - Phone:215-955-8435
Mailing Address - Street 1:, 1015 CHESTNUT STREET, SUITE 1321
Mailing Address - Street 2:
Mailing Address - City:PH19107ILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19107
Mailing Address - Country:US
Mailing Address - Phone:215-955-8354
Mailing Address - Fax:215-955-2342
Practice Address - Street 1:1015 CHESTNUT ST STE 1321
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19107-4313
Practice Address - Country:US
Practice Address - Phone:215-955-8354
Practice Address - Fax:215-955-2342
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-12
Last Update Date:2017-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP007945363LA2100X
PAVP005103D363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute CareGroup - Single Specialty
No363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatricsGroup - Single Specialty