Healthcare Provider Details

I. General information

NPI: 1962589002
Provider Name (Legal Business Name): JESSICA HOFFMAN NURSE PRACTIONER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 05/12/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4790 E CAMP LOWELL DR
TUCSON AZ
85712-1275
US

IV. Provider business mailing address

4790 E CAMP LOWELL DR
TUCSON AZ
85712-1275
US

V. Phone/Fax

Practice location:
  • Phone: 520-319-5922
  • Fax:
Mailing address:
  • Phone: 520-319-5922
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License NumberRN083524
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: