Provider Demographics
NPI:1730162470
Name:HOFFMAN, JUDY LYNN (NP)
Entity type:Individual
Prefix:
First Name:JUDY
Middle Name:LYNN
Last Name:HOFFMAN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6097 SONNY LN
Mailing Address - Street 2:
Mailing Address - City:CRESTVIEW
Mailing Address - State:FL
Mailing Address - Zip Code:32539-8658
Mailing Address - Country:US
Mailing Address - Phone:770-617-1182
Mailing Address - Fax:
Practice Address - Street 1:4413 US HIGHWAY 331 S
Practice Address - Street 2:
Practice Address - City:DEFUNIAK SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32435-6307
Practice Address - Country:US
Practice Address - Phone:850-920-2065
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-11-28
Last Update Date:2025-10-10
Deactivation Date:2025-09-12
Deactivation Code:
Reactivation Date:2025-10-09
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11025236363L00000X
GARN169860363LF0000X
TX715359363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX179449701Medicaid
GA616059616Medicaid
TX8N9920OtherBCBS OF TX
TX179449704OtherCIDC
TX8G5625Medicare PIN
TX179449704OtherCIDC
GA202I503918Medicare Oscar/Certification