Healthcare Provider Details

I. General information

NPI: 1740646868
Provider Name (Legal Business Name): TIFFANY HOFFMAN MIDWIFE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/05/2016
Last Update Date: 07/19/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12 W TAYLOR ST
RENO NV
89509-1724
US

IV. Provider business mailing address

12 W TAYLOR ST
RENO NV
89509-1724
US

V. Phone/Fax

Practice location:
  • Phone: 775-338-0755
  • Fax: 775-204-9155
Mailing address:
  • Phone: 775-338-0755
  • Fax: 775-204-9155

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code176B00000X
TaxonomyMidwife
License NumberLM484
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: