Healthcare Provider Details

I. General information

NPI: 1144735812
Provider Name (Legal Business Name): JENNIFER L FRUSCO CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/04/2017
Last Update Date: 10/14/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 OLD YORK RD STE 2B
ABINGTON PA
19001-3720
US

IV. Provider business mailing address

2500 MARYLAND RD STE 400
WILLOW GROVE PA
19090-1225
US

V. Phone/Fax

Practice location:
  • Phone: 215-481-2222
  • Fax: 215-481-4361
Mailing address:
  • Phone: 215-481-4143
  • Fax: 215-481-6790

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberSP018207
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License NumberSP018207
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: