Provider Demographics
NPI:1558884775
Name:HOFFMAN'S APRN-CNP MEDICAL CLINIC
Entity Type:Organization
Organization Name:HOFFMAN'S APRN-CNP MEDICAL CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALER
Authorized Official - Prefix:
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:
Authorized Official - Last Name:TIFFEE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:918-635-3566
Mailing Address - Street 1:29035 205TH AVE
Mailing Address - Street 2:
Mailing Address - City:POTEAU
Mailing Address - State:OK
Mailing Address - Zip Code:74953-7157
Mailing Address - Country:US
Mailing Address - Phone:918-653-2918
Mailing Address - Fax:918-653-3211
Practice Address - Street 1:102 SMITH AVE
Practice Address - Street 2:
Practice Address - City:POTEAU
Practice Address - State:OK
Practice Address - Zip Code:74953-2615
Practice Address - Country:US
Practice Address - Phone:918-653-2918
Practice Address - Fax:918-653-3211
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-19
Last Update Date:2017-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK28587261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200474150Medicaid