Basic Information
| Provider Information | |||||||||
| NPI: | 1548475304 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | TOBIAS | ||||||||
| FirstName: | JANE | ||||||||
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| Credential: | CRNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2000 SPROUL ROAD | ||||||||
| Address2: | SUITE 206 | ||||||||
| City: | BROOMALL | ||||||||
| State: | PA | ||||||||
| PostalCode: | 19008 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6102840200 | ||||||||
| FaxNumber: | 6103537932 | ||||||||
| Practice Location | |||||||||
| Address1: | 2000 SPROUL ROAD | ||||||||
| Address2: | SUITE 206 | ||||||||
| City: | BROOMALL | ||||||||
| State: | PA | ||||||||
| PostalCode: | 19008 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6102840200 | ||||||||
| FaxNumber: | 6103537932 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/14/2007 | ||||||||
| LastUpdateDate: | 12/16/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LP0200X | TP005743D | PA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Pediatrics |
ID Information
| ID | Type | State | Issuer | Description | 19990649 | 01 | PA | NURSE CERTIFICATE | OTHER | 003809 | 01 | PA | PRESCRIPTION AUTH | OTHER | TP005743D | 01 | PA | CRNP LICENSE | OTHER | RN279879L | 01 | PA | RN LICENSE | OTHER |