Provider Demographics
NPI:1093780967
Name:HOFFMAN, THERESA MENAVICH (CRNP)
Entity Type:Individual
Prefix:
First Name:THERESA
Middle Name:MENAVICH
Last Name:HOFFMAN
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:THERESA
Other - Middle Name:HELENE
Other - Last Name:MENAVICH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNP
Mailing Address - Street 1:411 E TURNBERRY CT
Mailing Address - Street 2:
Mailing Address - City:WEST CHESTER
Mailing Address - State:PA
Mailing Address - Zip Code:19382-2315
Mailing Address - Country:US
Mailing Address - Phone:610-793-0764
Mailing Address - Fax:
Practice Address - Street 1:700 N FRANKLIN ST
Practice Address - Street 2:
Practice Address - City:WEST CHESTER
Practice Address - State:PA
Practice Address - Zip Code:19380-2334
Practice Address - Country:US
Practice Address - Phone:610-696-5211
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-22
Last Update Date:2018-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP003495H363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001917253Medicaid
S49796Medicare UPIN
PA006671Medicare ID - Type Unspecified