Healthcare Provider Details

I. General information

NPI: 1922843614
Provider Name (Legal Business Name): JACLYN HOFFMAN RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/26/2024
Last Update Date: 06/26/2024
Certification Date: 06/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3409 WHITNEY AVE APT 4
HAMDEN CT
06518-1958
US

IV. Provider business mailing address

3409 WHITNEY AVE APT 4
HAMDEN CT
06518-1958
US

V. Phone/Fax

Practice location:
  • Phone: 413-454-2418
  • Fax:
Mailing address:
  • Phone: 413-454-2418
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0200X
TaxonomyPediatric Registered Nurse
License Number192790
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: