Healthcare Provider Details

I. General information

NPI: 1306490248
Provider Name (Legal Business Name): JACQUELYNN MARIE HOFFMAN APRN-CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/29/2019
Last Update Date: 07/29/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

807 E WASHINGTON ST STE 220
MEDINA OH
44256-3330
US

IV. Provider business mailing address

3593 MEDINA RD # 181
MEDINA OH
44256-8182
US

V. Phone/Fax

Practice location:
  • Phone: 330-536-3746
  • Fax:
Mailing address:
  • Phone: 330-536-3746
  • Fax: 330-267-4250

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPRN.CNP.025280
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: