Healthcare Provider Details

I. General information

NPI: 1356266779
Provider Name (Legal Business Name): JESSICA PENN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/13/2026
Last Update Date: 08/13/2026
Certification Date: 08/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3400 SPRUCE ST
PHILADELPHIA PA
19104-4238
US

IV. Provider business mailing address

113 IRON MASTER RD
CHERRY HILL NJ
08034-3363
US

V. Phone/Fax

Practice location:
  • Phone: 215-662-4000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LC0200X
TaxonomyCritical Care Medicine Nurse Practitioner
License NumberSP036675
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: