Provider Demographics
NPI:1801394085
Name:HACKENBURG, PATRICIA ANN
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:ANN
Last Name:HACKENBURG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:PATRICIA
Other - Middle Name:ANN
Other - Last Name:HOFELICH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:FNP-C
Mailing Address - Street 1:5940 OAK POINT RD
Mailing Address - Street 2:
Mailing Address - City:LORAIN
Mailing Address - State:OH
Mailing Address - Zip Code:44053-4100
Mailing Address - Country:US
Mailing Address - Phone:440-988-3705
Mailing Address - Fax:440-988-7433
Practice Address - Street 1:5940 OAK POINT RD
Practice Address - Street 2:
Practice Address - City:LORAIN
Practice Address - State:OH
Practice Address - Zip Code:44053-4100
Practice Address - Country:US
Practice Address - Phone:440-988-3705
Practice Address - Fax:440-988-7433
Is Sole Proprietor?:No
Enumeration Date:2018-01-23
Last Update Date:2019-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.021824363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily