Provider Demographics
NPI:1114704483
Name:HOFFMAN, JACOB TIMOTHY
Entity Type:Individual
Prefix:
First Name:JACOB
Middle Name:TIMOTHY
Last Name:HOFFMAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11007 QUAKER AVE
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79424-8317
Mailing Address - Country:US
Mailing Address - Phone:806-701-4040
Mailing Address - Fax:806-701-4041
Practice Address - Street 1:11007 QUAKER AVE
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79424-8317
Practice Address - Country:US
Practice Address - Phone:806-701-4040
Practice Address - Fax:806-701-4041
Is Sole Proprietor?:No
Enumeration Date:2023-09-11
Last Update Date:2023-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1137551363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily