Healthcare Provider Details

I. General information

NPI: 1760030084
Provider Name (Legal Business Name): DAVA CHRISTINE HOFFMAN PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/29/2019
Last Update Date: 07/21/2021
Certification Date: 07/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1723 BROADWAY ST STE 315
CAPE GIRARDEAU MO
63701-4556
US

IV. Provider business mailing address

303 N GEORGIA ST
JACKSON MO
63755-1412
US

V. Phone/Fax

Practice location:
  • Phone: 573-519-4960
  • Fax:
Mailing address:
  • Phone: 636-377-9047
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: