Healthcare Provider Details

I. General information

NPI: 1265764849
Provider Name (Legal Business Name): ALYSSA JOAN HOFFMANN PNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/05/2010
Last Update Date: 02/05/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10941 RAVEN RIDGE RD SUITE 105
RALEIGH NC
27614-6487
US

IV. Provider business mailing address

10941 RAVEN RIDGE RD SUITE 105
RALEIGH NC
27614-6487
US

V. Phone/Fax

Practice location:
  • Phone: 919-235-0543
  • Fax: 919-235-0542
Mailing address:
  • Phone: 919-235-0543
  • Fax: 919-235-0542

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number5004638
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: