Healthcare Provider Details

I. General information

NPI: 1629967898
Provider Name (Legal Business Name): JACQUELINE HOFFMAN PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/01/2025
Last Update Date: 10/01/2026
Certification Date: 10/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4539 N 22ND ST STE R
PHOENIX AZ
85016-4639
US

IV. Provider business mailing address

4539 N 22ND ST STE R
PHOENIX AZ
85016-4639
US

V. Phone/Fax

Practice location:
  • Phone: 480-478-2746
  • Fax: 480-323-2066
Mailing address:
  • Phone: 480-478-2746
  • Fax: 480-323-2066

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number326137
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: