Individual provider Active NPI

Jennifer Holloway, CRNP

  • Family Nurse Practitioner
  • Philadelphia, PA
National Provider Identifier
1447564471
Registry record updated Dec 17, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
SP010727 Issued in PA
Practice address
909 Walnut St FL 3
Philadelphia, PA 19107-5211
Phone
(215) 955-7000
NPI assigned
Aug 2, 2010
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 17, 2012

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Registered Nurse 163W00000X RN553234 PA
Family Nurse Practitioner 363LF0000X SP010727 PA Primary

Addresses

Primary practice location

909 Walnut St FL 3
Philadelphia, PA 19107-5211

Mailing address

240 Fir Tree CT
Marlton, NJ 08053-2010
Phone (856) 313-1105

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20180924000906 PA Practitioner - Nurse Practitioner 0749452373 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2009
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Jefferson University PhysiciansGroup PAC ID 7911819180, 1,528 clinicians

Practice addresses (Care Compare)

909 Walnut St
2ND Floor
Philadelphia, PA 19107-5211
Phone (215) 955-7000

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
RN553234PAMDRegistered Nurse

Practice roles

OrganizationSpecialtyStatusNew patients
Jefferson University Physicians CurrentSince Aug 7, 2018 Accepting new patients
Jefferson University Physicians Past Accepting new patients

Locations

925 Chestnut St
Fl 6
Philadelphia, PA 19107
Phone (215) 955-6760

909 Walnut St
Fl 2
Philadelphia, PA 19107
Phone (215) 955-1234

909 Walnut St
#2
Philadelphia, PA 19107
Phone (215) 955-7000

909 Walnut St
Fl 3
Philadelphia, PA 19107
Phone (215) 503-7008

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1280707200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1355702400000",
    "number": "1447564471",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "240 FIR TREE CT",
            "city": "MARLTON",
            "state": "NJ",
            "postal_code": "080532010",
            "telephone_number": "856-313-1105"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "909 WALNUT ST FL 3",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191075211",
            "telephone_number": "215-955-7000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HOLLOWAY",
        "first_name": "JENNIFER",
        "name_prefix": "Ms.",
        "credential": "CRNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-08-02",
        "last_updated": "2012-12-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "PA",
            "license": "RN553234",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "PA",
            "license": "SP010727",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Philadelphia, PA

Sources for this page

Verify at the official NPI Registry.