Provider Demographics
NPI:1245980242
Name:SMITH, JENNIFER ANN (CRNP)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:ANN
Last Name:SMITH
Suffix:
Gender:
Credentials:CRNP
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:ANN
Other - Last Name:SCOTT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3600 SPRUCE ST
Mailing Address - Street 2:5 DULLES
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19104-4206
Mailing Address - Country:US
Mailing Address - Phone:215-349-8310
Mailing Address - Fax:215-893-7270
Practice Address - Street 1:3400 SPRUCE ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19104-3309
Practice Address - Country:US
Practice Address - Phone:215-349-8310
Practice Address - Fax:215-893-7270
Is Sole Proprietor?:No
Enumeration Date:2022-03-24
Last Update Date:2025-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP025436363LG0600X, 363LA2100X, 363LA2100X
FLAPRN11014206363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner