Healthcare Provider Details

I. General information

NPI: 1164449765
Provider Name (Legal Business Name): LISA M HOFFMAN FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: LISA M VIGNEAU FNP-C

II. Dates (important events)

Enumeration Date: 07/17/2006
Last Update Date: 10/10/2023
Certification Date: 10/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2325 SUMMIT PARK DR SUITE 3
PETOSKEY MI
49770-8774
US

IV. Provider business mailing address

2325 SUMMIT PARK DR SUITE 3
PETOSKEY MI
49770-8774
US

V. Phone/Fax

Practice location:
  • Phone: 231-439-5100
  • Fax: 231-439-9292
Mailing address:
  • Phone: 231-439-5100
  • Fax: 231-439-9292

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number4704206725
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: