Provider Demographics
NPI:1689740508
Name:HOTRUM, TONJA LYNN (PA-C)
Entity Type:Individual
Prefix:
First Name:TONJA
Middle Name:LYNN
Last Name:HOTRUM
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1389 HUFFMAN PARK DR UNIT 210
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99515-3534
Mailing Address - Country:US
Mailing Address - Phone:907-250-0571
Mailing Address - Fax:907-600-5083
Practice Address - Street 1:1389 HUFFMAN PARK DR UNIT 210
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99515-3534
Practice Address - Country:US
Practice Address - Phone:907-250-0571
Practice Address - Fax:907-600-5083
Is Sole Proprietor?:No
Enumeration Date:2006-11-24
Last Update Date:2022-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK1816363AM0700X
AK752363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKMD2379Medicaid
TXPA 01254OtherTEXAS PA LICENSE
TXPA 01254OtherTEXAS PA LICENSE