Healthcare Provider Details

I. General information

NPI: 1104853498
Provider Name (Legal Business Name): CARDIOPULMONARY ASSOCIATES OF THE TREASURE COAST PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/26/2006
Last Update Date: 12/17/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1801 SE HILLMOOR DR A110
PORT ST LUCIE FL
34952-7553
US

IV. Provider business mailing address

1801 SE HILLMOOR DR A110
PORT ST LUCIE FL
34952-7553
US

V. Phone/Fax

Practice location:
  • Phone: 772-335-3500
  • Fax: 772-335-1361
Mailing address:
  • Phone: 772-335-3500
  • Fax: 772-335-1361

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberME0032775
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License NumberME842328
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License NumberME93466
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number028759
License Number StateFL
# 5
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberOS8311
License Number StateFL
# 6
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberRN2784382
License Number StateFL
# 7
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberARNP9293900
License Number StateFL
# 8
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberARNP9236500
License Number StateFL

VIII. Authorized Official

Name: DR. DONALD B HOFFMAN
Title or Position: OWNER
Credential: MD
Phone: 772-335-3500