Provider Demographics
NPI:1366454951
Name:HOFFSTETTER, JOHN MATHEW (PA-C)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:MATHEW
Last Name:HOFFSTETTER
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10516 W SAMPLE RD
Mailing Address - Street 2:
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33065-3740
Mailing Address - Country:US
Mailing Address - Phone:719-538-7861
Mailing Address - Fax:
Practice Address - Street 1:3000 N UNIVERSITY DR
Practice Address - Street 2:SUITE K
Practice Address - City:CORAL SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33065-5055
Practice Address - Country:US
Practice Address - Phone:954-752-2630
Practice Address - Fax:954-755-1865
Is Sole Proprietor?:No
Enumeration Date:2006-08-12
Last Update Date:2016-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9106128363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLGM636ZOtherMEDICARE