Healthcare Provider Details

I. General information

NPI: 1699596460
Provider Name (Legal Business Name): GEORGE SAMUEL HOFFMAN FNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/23/2024
Last Update Date: 10/23/2024
Certification Date: 10/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1360 BRICKYARD RD
CHIPLEY FL
32428-6303
US

IV. Provider business mailing address

4980 FLOWERS CHAPEL RD APT R131
DOTHAN AL
36305-5322
US

V. Phone/Fax

Practice location:
  • Phone: 850-415-8310
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number11036167
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: