Provider Demographics
NPI:1336126739
Name:HOFMANN, JOANNA FRANCES (NP)
Entity Type:Individual
Prefix:
First Name:JOANNA
Middle Name:FRANCES
Last Name:HOFMANN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3211 73RD ST
Mailing Address - Street 2:
Mailing Address - City:EAST ELMHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11370-1705
Mailing Address - Country:US
Mailing Address - Phone:718-565-5978
Mailing Address - Fax:718-565-5978
Practice Address - Street 1:1844 2ND AVE
Practice Address - Street 2:THIRD FLOOR MEDICAL OFFICE
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10128-3862
Practice Address - Country:US
Practice Address - Phone:212-410-0033
Practice Address - Fax:212-410-5180
Is Sole Proprietor?:No
Enumeration Date:2005-12-27
Last Update Date:2012-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF303082-1363LA2200X
NYF340596363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYP38057Medicare UPIN
NY2E3411Medicare ID - Type UnspecifiedPROVIDER NUMBER