Provider Demographics
NPI: | 1174651913 |
---|---|
Name: | HOFFMAN, AMBER EVON (FNP) |
Entity Type: | Individual |
Prefix: | |
First Name: | AMBER |
Middle Name: | EVON |
Last Name: | HOFFMAN |
Suffix: | |
Gender: | F |
Credentials: | FNP |
Other - Prefix: | |
Other - First Name: | AMBER |
Other - Middle Name: | EVON |
Other - Last Name: | ALBRECHT |
Other - Suffix: | |
Other - Last Name Type: | Former Name |
Other - Credentials: | RN |
Mailing Address - Street 1: | 2321 HARRISON AVE |
Mailing Address - Street 2: | |
Mailing Address - City: | EUREKA |
Mailing Address - State: | CA |
Mailing Address - Zip Code: | 95501-3216 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 707-442-4175 |
Mailing Address - Fax: | 707-445-1722 |
Practice Address - Street 1: | 2321 HARRISON AVE |
Practice Address - Street 2: | |
Practice Address - City: | EUREKA |
Practice Address - State: | CA |
Practice Address - Zip Code: | 95501-3216 |
Practice Address - Country: | US |
Practice Address - Phone: | 707-442-4175 |
Practice Address - Fax: | 707-445-1722 |
Is Sole Proprietor?: | No |
Enumeration Date: | 2007-03-01 |
Last Update Date: | 2021-11-03 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
CA | 698850 | 163W00000X, 163WR0006X |
CA | 95002563 | 363LF0000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 363LF0000X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No | 163W00000X | Nursing Service Providers | Registered Nurse | |
No | 163WR0006X | Nursing Service Providers | Registered Nurse | Registered Nurse First Assistant |