Healthcare Provider Details

I. General information

NPI: 1215305628
Provider Name (Legal Business Name): NICOLE LEE HOFFMAN PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/02/2015
Last Update Date: 08/05/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10800 KNIGHTS RD
PHILADELPHIA PA
19114-4200
US

IV. Provider business mailing address

10 NORTH DR
TABERNACLE NJ
08088-8657
US

V. Phone/Fax

Practice location:
  • Phone: 215-612-4963
  • Fax: 215-612-4532
Mailing address:
  • Phone: 609-760-6092
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberOA003610
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberMA057776
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: