Healthcare Provider Details

I. General information

NPI: 1295544781
Provider Name (Legal Business Name): TATENDA HOFISI NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/30/2024
Last Update Date: 06/02/2025
Certification Date: 06/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2415 E CAMELBACK RD STE 700
PHOENIX AZ
85016-4245
US

IV. Provider business mailing address

315 W MCLAIN DR
SHERMAN TX
75092-2605
US

V. Phone/Fax

Practice location:
  • Phone: 469-254-0202
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number1171223
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: