Healthcare Provider Details

I. General information

NPI: 1831703461
Provider Name (Legal Business Name): MADELEINE JAKE HOFFMAN PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MADELEINE JAKE NIESLANIK

II. Dates (important events)

Enumeration Date: 09/01/2020
Last Update Date: 06/11/2025
Certification Date: 06/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

195 W 14TH BLDG C
RIFLE CO
81650-4717
US

IV. Provider business mailing address

PO BOX 339
GLENWOOD SPRINGS CO
81602-0339
US

V. Phone/Fax

Practice location:
  • Phone: 970-945-2840
  • Fax: 970-945-2893
Mailing address:
  • Phone: 970-319-2691
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA.0007384
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: