Healthcare Provider Details

I. General information

NPI: 1568940534
Provider Name (Legal Business Name): HANNAH LEE HOFFMAN PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/01/2018
Last Update Date: 07/18/2025
Certification Date: 07/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2402 FRIST BLVD STE 201
FORT PIERCE FL
34950-4838
US

IV. Provider business mailing address

2402 FRIST BLVD STE 201
FORT PIERCE FL
34950-4838
US

V. Phone/Fax

Practice location:
  • Phone: 772-252-6620
  • Fax: 772-460-8808
Mailing address:
  • Phone: 772-252-6620
  • Fax: 772-460-8808

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number10004901A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA9111414
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: