Provider Demographics
NPI:1063450039
Name:HOFMAN, JACQUELINE A (CRNA)
Entity Type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:A
Last Name:HOFMAN
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 880756
Mailing Address - Street 2:
Mailing Address - City:STEAMBOAT SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:90488
Mailing Address - Country:US
Mailing Address - Phone:970-870-1972
Mailing Address - Fax:
Practice Address - Street 1:31525 ASPEN RIDGE RD.
Practice Address - Street 2:
Practice Address - City:STEAMBOAT SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:90488
Practice Address - Country:US
Practice Address - Phone:970-870-1972
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-03
Last Update Date:2013-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO174030367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO92234861Medicaid
MD770203500Medicaid
601285800OtherFECA
601285800OtherFECA
015880F85Medicare ID - Type UnspecifiedG01485
839MK380Medicare ID - Type Unspecified839M
COC304503Medicare PIN
CO92234861Medicaid