Healthcare Provider Details

I. General information

NPI: 1366485724
Provider Name (Legal Business Name): ELIZABETH A HOFFMAN PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/14/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4040 COON RAPIDS BLVD NW SUITE 120
MINNEAPOLIS MN
55433-2522
US

IV. Provider business mailing address

4040 COON RAPIDS BLVD NW SUITE 120
MINNEAPOLIS MN
55433-2522
US

V. Phone/Fax

Practice location:
  • Phone: 763-427-9980
  • Fax: 763-427-9908
Mailing address:
  • Phone: 763-427-9980
  • Fax: 763-427-9908

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number9788
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: