Provider Demographics
NPI:1609492214
Name:HOFFMAN, JENNA
Entity Type:Individual
Prefix:
First Name:JENNA
Middle Name:
Last Name:HOFFMAN
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 1:610 E ROOSEVELT RD
Mailing Address - Street 2:
Mailing Address - City:PHILO
Mailing Address - State:IL
Mailing Address - Zip Code:61864-9763
Mailing Address - Country:US
Mailing Address - Phone:217-714-1765
Mailing Address - Fax:
Practice Address - Street 1:1001 E PELLS ST
Practice Address - Street 2:
Practice Address - City:PAXTON
Practice Address - State:IL
Practice Address - Zip Code:60957-1300
Practice Address - Country:US
Practice Address - Phone:815-216-4335
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-19
Last Update Date:2022-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041395936163W00000X
IL209021559363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse