MEDICARE: MS. JENNIFER L GROSS CRNP

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	363LF0000X	Family Nurse Practitioner	SP008852	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	50056705	OTHER	PA	CAPITAL BLUE CROSS-WMG
2	102865	OTHER	PA	JOHNS HOPKINS
3	648909	OTHER	MD	CAREFIRST MD BCBS
4	1556938	OTHER	PA	GATEWAY-WMG
5	1916724	OTHER	PA	HIGHMARK FREEDOM BLUE

General Provider Information

NPI Number	:	1407888183
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. JENNIFER L GROSS CRNP

Provider Business Mailing Address
First Line	:	3421 CONCORD RD
Second Line	:
City	:	YORK
State	:	PA
Zip	:	17402-9001
Country	:	US
Telephone Number	:	717-851-7315
Fax Number	:	717-741-3056

Provider Business Practice Location Address
First Line	:	300 PINE GROVE COMMONS
Second Line	:
City	:	YORK
State	:	PA
Zip	:	17403-5176
Country	:	US
Telephone Number	:	717-812-2143
Fax Number	:	717-812-2163

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

Provider Enumeration Date	:	07/06/2006
Last Update Date	:	06/26/2017

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