Healthcare Provider Details

I. General information

NPI: 1376056135
Provider Name (Legal Business Name): JESSICA ANNE HOFFMAN FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/14/2017
Last Update Date: 12/05/2022
Certification Date: 12/05/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

N5241 US HIGHWAY 45
WATERSMEET MI
49969-5115
US

IV. Provider business mailing address

N5241 US HIGHWAY 45
WATERSMEET MI
49969-5115
US

V. Phone/Fax

Practice location:
  • Phone: 906-358-4588
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number4704337936
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: