MEDICARE: THOMAS JEFFERSON UNIVERSITY HOSPITAL

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	363LP0200X	Pediatric Nurse Practitioner	VP005103D	PA
2	363LA2100X	Acute Care Nurse Practitioner	SP007945	PA

General Provider Information

NPI Number	:	1598292229
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THOMAS JEFFERSON UNIVERSITY HOSPITAL

Provider Business Mailing Address
First Line	:	, 1015 CHESTNUT STREET, SUITE 1321
Second Line	:
City	:	PH19107ILADELPHIA
State	:	PA
Zip	:	19107
Country	:	US
Telephone Number	:	215-955-8354
Fax Number	:	215-955-2342

Provider Business Practice Location Address
First Line	:	1015 CHESTNUT ST STE 1321
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19107-4313
Country	:	US
Telephone Number	:	215-955-8354
Fax Number	:	215-955-2342

Authorized Official
Title or Position	:	NURSE PRACTITIONER
Name	:	MS. SANDRA A MOSS
Credential	:	CRNP
Telephone Number	:	215-955-8435

Provider Enumeration Date	:	05/12/2017
Last Update Date	:	05/12/2017

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