Healthcare Provider Details

I. General information

NPI: 1629800727
Provider Name (Legal Business Name): JENNIFER NICOLE HOFFMAN FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/16/2024
Last Update Date: 11/25/2024
Certification Date: 11/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1116 MILLIS AVE STE 101
BOONVILLE IN
47601-2226
US

IV. Provider business mailing address

1116 MILLIS AVE STE 101
BOONVILLE IN
47601-2226
US

V. Phone/Fax

Practice location:
  • Phone: 812-897-7107
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number71015674A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: