Provider Demographics
NPI:1174843684
Name:HOFFMAN, JACQUELINE MERYL
Entity Type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:MERYL
Last Name:HOFFMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:421 S KEECH ST
Mailing Address - Street 2:
Mailing Address - City:DAYTONA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32114-4623
Mailing Address - Country:US
Mailing Address - Phone:386-238-4980
Mailing Address - Fax:
Practice Address - Street 1:421 S KEECH ST
Practice Address - Street 2:
Practice Address - City:DAYTONA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32114-4623
Practice Address - Country:US
Practice Address - Phone:386-238-4980
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-07
Last Update Date:2015-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator