Healthcare Provider Details

I. General information

NPI: 1821065301
Provider Name (Legal Business Name): TERESA J HOFFMANN CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/03/2006
Last Update Date: 01/13/2021
Certification Date: 01/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 PROSPECT AVE
SYRACUSE NY
13203-1807
US

IV. Provider business mailing address

4965 BRYN MAWR DR
SYRACUSE NY
13215-2255
US

V. Phone/Fax

Practice location:
  • Phone: 315-448-5440
  • Fax:
Mailing address:
  • Phone: 315-492-9450
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number286922
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: