Provider Demographics
NPI:1598931180
Name:HOFFSTETTER, JANE S
Entity Type:Individual
Prefix:
First Name:JANE
Middle Name:S
Last Name:HOFFSTETTER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2375 W SPRINGLAKE DR
Mailing Address - Street 2:
Mailing Address - City:DUNNELLON
Mailing Address - State:FL
Mailing Address - Zip Code:34434-2023
Mailing Address - Country:US
Mailing Address - Phone:352-489-2338
Mailing Address - Fax:
Practice Address - Street 1:2375 W SPRINGLAKE DR
Practice Address - Street 2:
Practice Address - City:DUNNELLON
Practice Address - State:FL
Practice Address - Zip Code:34434-2023
Practice Address - Country:US
Practice Address - Phone:352-489-2338
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-02
Last Update Date:2008-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL230472400Medicaid