Healthcare Provider Details

I. General information

NPI: 1528668241
Provider Name (Legal Business Name): DAVID DANIEL JOEL HOFFMAN II APRN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/30/2020
Last Update Date: 10/30/2020
Certification Date: 10/30/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

225 E JACKSON AVE
JONESBORO AR
72401-3119
US

IV. Provider business mailing address

403 JILL DR
JONESBORO AR
72404-8803
US

V. Phone/Fax

Practice location:
  • Phone: 870-207-5200
  • Fax:
Mailing address:
  • Phone: 870-759-2753
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberCNP125814
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: