Healthcare Provider Details

I. General information

NPI: 1306830880
Provider Name (Legal Business Name): WANDA DAVIS HOFFMAN ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/09/2005
Last Update Date: 02/01/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

307 BOATNER RD SUITE 114
EGLIN AFB FL
32542-1391
US

IV. Provider business mailing address

96 MDG SGOC
EGLIN AFB FL
32542
US

V. Phone/Fax

Practice location:
  • Phone: 850-883-8550
  • Fax: 850-883-8094
Mailing address:
  • Phone: 850-883-8780
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberARNP/RN 3113372
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: