Healthcare Provider Details

I. General information

NPI: 1255025508
Provider Name (Legal Business Name): CAROLINE ROSE HOFFMAN PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/07/2023
Last Update Date: 10/02/2025
Certification Date: 10/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12255 DEPAUL DRIVE SUITE 420
BRIDGETON MO
63044-2510
US

IV. Provider business mailing address

925 LYNWOOD FOREST DR
MANCHESTER MO
63021-5576
US

V. Phone/Fax

Practice location:
  • Phone: 314-298-3893
  • Fax: 314-851-4408
Mailing address:
  • Phone: 636-368-5257
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number2025039403
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: