Healthcare Provider Details

I. General information

NPI: 1275359382
Provider Name (Legal Business Name): MS. EMILIA ISIDORA HOFMANN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/23/2024
Last Update Date: 11/23/2024
Certification Date: 11/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

953 DANBY RD
ITHACA NY
14850-7002
US

IV. Provider business mailing address

917 NANDINA DR
WESTON FL
33327-2407
US

V. Phone/Fax

Practice location:
  • Phone: 607-274-7007
  • Fax:
Mailing address:
  • Phone: 954-610-8372
  • 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: