Healthcare Provider Details

I. General information

NPI: 1194127472
Provider Name (Legal Business Name): ANNA HOSKINS PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/18/2014
Last Update Date: 11/15/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1072 N LIBERTY STREET STE 201
BOISE ID
83704-8708
US

IV. Provider business mailing address

3340 E GOLDSTONE WAY
MERIDIAN ID
83642-1026
US

V. Phone/Fax

Practice location:
  • Phone: 208-377-2273
  • Fax: 208-367-3059
Mailing address:
  • Phone: 208-377-2273
  • Fax: 208-367-3059

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License NumberM-1319
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: