MEDICARE: JADE BRAZELL

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	363LA2100X	Acute Care Nurse Practitioner	SP034523	PA
2	363L00000X	Nurse Practitioner	SP034523	PA

General Provider Information

NPI Number	:	1720957038
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JADE BRAZELL

Provider Business Mailing Address
First Line	:	332 W HORTTER ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19119-3152
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	100 E LANCASTER AVE
Second Line	:	THE HEART PAVILLION MEZZANINE LEVEL
City	:	WYNNEWOOD
State	:	PA
Zip	:	19096-3450
Country	:	US
Telephone Number	:	484-476-1000
Fax Number	:	484-476-9000

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/04/2025
Last Update Date	:	02/09/2026

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Directions to “ JADE BRAZELL ” Practice Location

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