Provider Demographics
NPI:1578916656
Name:HOFFMAN, MELLISA R (NP)
Entity Type:Individual
Prefix:MRS
First Name:MELLISA
Middle Name:R
Last Name:HOFFMAN
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 1:618 PLEASANTVILLE RD STE 101
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:OH
Mailing Address - Zip Code:43130-3325
Mailing Address - Country:US
Mailing Address - Phone:740-653-7511
Mailing Address - Fax:740-653-7512
Practice Address - Street 1:618 PLEASANTVILLE RD STE 101
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:OH
Practice Address - Zip Code:43130-3325
Practice Address - Country:US
Practice Address - Phone:740-653-7511
Practice Address - Fax:740-653-7512
Is Sole Proprietor?:No
Enumeration Date:2016-07-13
Last Update Date:2019-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH390200000X
OHAPRN.CNP.020056363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH3038813Medicaid