Provider Demographics
NPI:1578919973
Name:HOFFMAN, MICHAEL RANDALL (PHD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:RANDALL
Last Name:HOFFMAN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 WHITE DOVE LN
Mailing Address - Street 2:
Mailing Address - City:PALM COAST
Mailing Address - State:FL
Mailing Address - Zip Code:32164-7247
Mailing Address - Country:US
Mailing Address - Phone:386-864-4394
Mailing Address - Fax:888-946-6584
Practice Address - Street 1:10 WHITE DOVE LN
Practice Address - Street 2:
Practice Address - City:PALM COAST
Practice Address - State:FL
Practice Address - Zip Code:32164-7247
Practice Address - Country:US
Practice Address - Phone:386-864-4394
Practice Address - Fax:888-946-6584
Is Sole Proprietor?:No
Enumeration Date:2016-05-04
Last Update Date:2019-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPPY203103TC0700X
FLPY9813103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical