Provider Demographics
NPI:1548475304
Name:TOBIAS, JANE (CRNP)
Entity type:Individual
Prefix:
First Name:JANE
Middle Name:
Last Name:TOBIAS
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2000 SPROUL ROAD
Mailing Address - Street 2:SUITE 206
Mailing Address - City:BROOMALL
Mailing Address - State:PA
Mailing Address - Zip Code:19008
Mailing Address - Country:US
Mailing Address - Phone:610-284-0200
Mailing Address - Fax:610-353-7932
Practice Address - Street 1:2000 SPROUL ROAD
Practice Address - Street 2:SUITE 206
Practice Address - City:BROOMALL
Practice Address - State:PA
Practice Address - Zip Code:19008
Practice Address - Country:US
Practice Address - Phone:610-284-0200
Practice Address - Fax:610-353-7932
Is Sole Proprietor?:No
Enumeration Date:2007-05-14
Last Update Date:2014-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PATP005743D363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA19990649OtherNURSE CERTIFICATE
PA003809OtherPRESCRIPTION AUTH
PATP005743DOtherCRNP LICENSE
PARN279879LOtherRN LICENSE