Healthcare Provider Details

I. General information

NPI: 1558884775
Provider Name (Legal Business Name): HOFFMAN'S APRN-CNP MEDICAL CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/19/2017
Last Update Date: 07/19/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

102 SMITH AVE
POTEAU OK
74953-2615
US

IV. Provider business mailing address

29035 205TH AVE
POTEAU OK
74953-7157
US

V. Phone/Fax

Practice location:
  • Phone: 918-653-2918
  • Fax: 918-653-3211
Mailing address:
  • Phone: 918-653-2918
  • Fax: 918-653-3211

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number28587
License Number StateOK

VIII. Authorized Official

Name: DEBRA TIFFEE
Title or Position: CREDENTIALER
Credential:
Phone: 918-635-3566