IDA ELISE BROADWATER


Address: 3400 Spruce Street, 6 Silverstein, Philadelphia, PA 19104
Phone: 2156154949

IDA ELISE BROADWATER (NPI# 1598195307) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).

Provider Overview

Nation Provider ID (NPI) 1598195307
Entity Type Individual
Full Name IDA ELISE BROADWATER
Credential CRNP
Practice Address 3400 Spruce Street
6 Silverstein
Philadelphia
PA 19104
Practice Telephone 2156154949
Mailing Telephone 2156154949
Enumeration Date 2013-11-14
Last Update Date 2013-12-20
Gender Code F
Is Sole Proprietor N

Taxonomy

Primary Taxonomy Code Classification License Number License State Taxonomy Group
Y 363LA2200X Nurse Practitioner
Specialization: Adult Health
SP013545 PA Physician Assistants & Advanced Practice Nursing Providers

Office Location

Street Address 3400 SPRUCE STREET
6 SILVERSTEIN
City PHILADELPHIA
State PA
Zip Code 19104

Providers in the same location

NPI Name Taxonomy Address Enumeration
1184620296 Anne M Foley Nurse Practitioner 3400 Spruce Street, 4 Silverstein, Philadelphia, PA 19104-4206 2005-06-23
1063023349 Judith Christina Rivera Nurse Practitioner 3400 Spruce Street, Cicu F11, Philadelphia, PA 19104-4238 2020-08-11
1457970451 Tyler J York Student in an Organized Health Care Education/Training Program 3400 Spruce Street, 4 Maloney - Surgery Education Office, Philadelphia, PA 19104 2020-04-10
1811532088 Madeleine Liu Rutledge Nurse Practitioner 3400 Spruce Street, Dulles 6, Philadelphia, PA 19104 2019-11-12
1497397160 Brittany Nichol Moses Physician Assistant 3400 Spruce Street, Rhoads 5, Philadelphia, PA 19104 2019-10-14
1477106011 Courtney Condit Genetic Counselor, MS 3400 Spruce Street, 5 Silverstein, Suite 5100, Philadelphia, PA 19104 2019-07-23
1275096745 Dallas Argueso Student in an Organized Health Care Education/Training Program 3400 Spruce Street, 100 Centrex, Philadelphia, PA 19104 2019-04-10
1720548837 Alisha Jamil Student in an Organized Health Care Education/Training Program 3400 Spruce Street, 100 Centrex, Philadelphia, PA 19104 2019-03-24
1023578507 Erin Killingsworth Mcminn Student in an Organized Health Care Education/Training Program 3400 Spruce Street, 1 West Gates, Philadelphia, PA 19104 2019-03-21
1932669694 Rosa Speranza Student in an Organized Health Care Education/Training Program 3400 Spruce Street, 1 W. Gates, Philadelphia, PA 19104 2019-03-20
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Providers in the same zip code

NPI Name Taxonomy Address Enumeration
1639770829 Michelle Morris Student in an Organized Health Care Education/Training Program Dept. of Family Medicine & Community Health, 3737 Market, Philadelphia, PA 19104 2020-11-04
1346853041 Spectrum Health Services, Inc. Clinic/Center 1415 South University Ave, Philadelphia, PA 19104 2020-08-24
1770104259 Fatimah Sorefan-mangou Student in an Organized Health Care Education/Training Program 4 Maloney 3400 Spruce Street, Philadelphia, PA 19104 2020-05-06
1114548690 Rebecca Blaguski Registered Nurse The Hospital of The University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104 2020-05-06
1952944175 Rebecca Miriam Barmherzig Psychiatry & Neurology 3501 Civic Centre Blvd, 10th Flr Ctrb, Neurology, Philadelphia, PA 19104 2019-10-21
1891257101 James Paul Byrne Surgery Penn Presbyterian Medical Center, Division of Trauma, S, 51 N. 39th Street, Suite 120, 1st Floor Medical Office, Philadelphia, PA 19104 2019-04-04
1093276453 Lauren Shreve Student in an Organized Health Care Education/Training Program Department of Surgery, Surgery Education - Penn Health, 3400 Spruce Street, 4 Maloney, Philadelphia, PA 19104 2019-03-28
1285194282 Lauren M Christie Student in an Organized Health Care Education/Training Program Penn Presbyterian Medical Center, 51 N. 39th Street, Philadelphia, PA 19104 2019-03-25
1114487683 Sabrina Layne Student in an Organized Health Care Education/Training Program 3400 Spruce Street, 100 Centrex, Philadelphia, PA 19104 2019-03-21
1811457310 Kia Lor Student in an Organized Health Care Education/Training Program Hospital of University of Pennsylvania, 3400 Spruce St., Philadelphia, PA 19104 2019-03-21
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Taxonomy Information

Taxonomy Code 363LA2200X
Grouping Physician Assistants & Advanced Practice Nursing Providers
Classification Nurse Practitioner
Specialization Adult Health

Taxonomy Definition

Definition to come...

Providers in the same taxonomy and city

NPI Name Taxonomy Address Enumeration
1841834710 Joseph Mascaro Nurse Practitioner 125 S 9th St Ste 1005, Philadelphia, PA 19107-5123 2019-11-04
1780185835 Neva White Nurse Practitioner 211 S 9th St Ste 300, Philadelphia, PA 19107-6810 2018-02-23
1790298487 Anne Kathryn Henner Nurse Practitioner 925 Chestnut St Ste 420a, Philadelphia, PA 19107-4247 2017-11-16
1174052997 Cynthia Wheeler Nurse Practitioner 925 Chestnut St # 421d, Philadelphia, PA 19107-4216 2017-06-06
1740716893 Liliya Gurevich Nurse Practitioner 7906 Frontenac St, Philadelphia, PA 19111-2902 2017-05-11
1235589664 Juliana Omile Nurse Practitioner 7521 Woodcrest Ave, Philadelphia, PA 19151-2702 2016-06-16
1275980468 Joji Thomas Nurse Practitioner 9659 Sandanne Rd, Philadelphia, PA 19115-2727 2016-05-18
1073988374 Cristhi Wilson-brown Nurse Practitioner 521 W Girard Ave, Philadelphia, PA 19123-1428 2015-12-11
1932579984 Tierney A Fisher Nurse Practitioner 3737 Market St Fl 10, Philadelphia, PA 19104-5545 2015-10-03
1306223813 Anthony Yaroslav Fisun Nurse Practitioner 2008 President St, Philadelphia, PA 19115-2607 2015-05-04
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Competitor

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City PHILADELPHIA
Zip Code 19104

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Dataset Information

Data Provider Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES)
Jurisdiction Medicare & Medicaid

This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.

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