Provider Demographics
NPI:1164449765
Name:HOFFMAN, LISA M (FNP-C)
Entity Type:Individual
Prefix:MS
First Name:LISA
Middle Name:M
Last Name:HOFFMAN
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:MS
Other - First Name:LISA
Other - Middle Name:M
Other - Last Name:VIGNEAU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP-C
Mailing Address - Street 1:2325 SUMMIT PARK DR
Mailing Address - Street 2:SUITE 3
Mailing Address - City:PETOSKEY
Mailing Address - State:MI
Mailing Address - Zip Code:49770-8774
Mailing Address - Country:US
Mailing Address - Phone:231-439-5100
Mailing Address - Fax:231-439-9292
Practice Address - Street 1:2325 SUMMIT PARK DR
Practice Address - Street 2:SUITE 3
Practice Address - City:PETOSKEY
Practice Address - State:MI
Practice Address - Zip Code:49770-8774
Practice Address - Country:US
Practice Address - Phone:231-439-5100
Practice Address - Fax:231-439-9292
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-17
Last Update Date:2023-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704206725363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
S99346Medicare UPIN