Healthcare Provider Details

I. General information

NPI: 1467116665
Provider Name (Legal Business Name): TYLER HOFFMANN APRN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/25/2021
Last Update Date: 10/25/2021
Certification Date: 10/25/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4350 DEWEY AVE
OMAHA NE
68198-7501
US

IV. Provider business mailing address

4350 DEWEY AVE
OMAHA NE
68198-7501
US

V. Phone/Fax

Practice location:
  • Phone: 402-559-2000
  • Fax:
Mailing address:
  • Phone: 402-559-2000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number113769
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: