MEDICARE: STEPHEN JACOB HOFFMAN CRNA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163WC0200X	Critical Care Medicine Registered Nurse	363283	OH
2	367500000X	Certified Registered Nurse Anesthetist	019684	OH

General Provider Information

NPI Number	:	1871096362
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEPHEN JACOB HOFFMAN CRNA

Provider Business Mailing Address
First Line	:	18940 SMOKEY RD
Second Line	:
City	:	MARYSVILLE
State	:	OH
Zip	:	43040-9194
Country	:	US
Telephone Number	:	330-603-8460
Fax Number	:

Provider Business Practice Location Address
First Line	:	205 E PALMER RD
Second Line	:
City	:	BELLEFONTAINE
State	:	OH
Zip	:	43311-2298
Country	:	US
Telephone Number	:	937-592-4015
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/12/2018
Last Update Date	:	03/05/2025

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