Provider Demographics
NPI:1629402482
Name:HOFSTETTER, CAMERON LEA (FNP)
Entity Type:Individual
Prefix:
First Name:CAMERON
Middle Name:LEA
Last Name:HOFSTETTER
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:206 S HORTON PKWY
Mailing Address - Street 2:
Mailing Address - City:CHAPEL HILL
Mailing Address - State:TN
Mailing Address - Zip Code:37034-3102
Mailing Address - Country:US
Mailing Address - Phone:931-364-4663
Mailing Address - Fax:
Practice Address - Street 1:206 S HORTON PKWY
Practice Address - Street 2:
Practice Address - City:CHAPEL HILL
Practice Address - State:TN
Practice Address - Zip Code:37034-3102
Practice Address - Country:US
Practice Address - Phone:931-364-4663
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-29
Last Update Date:2014-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN17883363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN10350I5045Medicare PIN