Healthcare Provider Details

I. General information

NPI: 1730162470
Provider Name (Legal Business Name): JUDY LYNN HOFFMAN N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/28/2005
Last Update Date: 10/10/2025
Certification Date: 10/10/2025
Deactivation Date: 09/12/2025
Reactivation Date: 10/09/2025

III. Provider practice location address

4413 US HIGHWAY 331 S
DEFUNIAK SPRINGS FL
32435-6307
US

IV. Provider business mailing address

6097 SONNY LN
CRESTVIEW FL
32539-8658
US

V. Phone/Fax

Practice location:
  • Phone: 850-920-2065
  • Fax:
Mailing address:
  • Phone: 770-617-1182
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPRN11025236
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN169860
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number715359
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: