Provider Demographics
NPI:1003079120
Name:HOFSTRA, JENNIFER A (MD)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:A
Last Name:HOFSTRA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3340 E GOLDSTONE WAY
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83642-1026
Mailing Address - Country:US
Mailing Address - Phone:208-367-7350
Mailing Address - Fax:208-367-3951
Practice Address - Street 1:1055 N CURTIS ROAD
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83706
Practice Address - Country:US
Practice Address - Phone:757-446-8920
Practice Address - Fax:757-446-5242
Is Sole Proprietor?:No
Enumeration Date:2008-07-09
Last Update Date:2016-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101247286207R00000X
IDM-13462207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAPAROtherMULTIPLAN
VAPAROtherAETNA
VAPAROtherUNITED HEALTH CARE/MAMSI
VAPAROtherFIRST HEALTH COMMERCIAL/COVENTRY HEALTH/SOUTHERN HEALTH
VAPAROtherUSA MANAGED CARE
VA1003079120Medicaid
VAPAROtherCORVEL/CORCARE
VAPAROtherVA PREMIER HEALTH
VAPAROtherVA HEALTH NETWORK
VA10060934OtherOPTIMA HEALTH
VA407988OtherANTHEM BC/BS
VAPAROtherCIGNA
NC5915448Medicaid
VA-028OtherTRICARE/CHAMPUS
VAPAROtherMULTIPLAN
VAVAA101009Medicare PIN