Provider Demographics
NPI:1639880065
Name:HOFFMAN, CARLENE MARIE (MSN, ARNP, FNP-BC)
Entity type:Individual
Prefix:MS
First Name:CARLENE
Middle Name:MARIE
Last Name:HOFFMAN
Suffix:
Gender:F
Credentials:MSN, ARNP, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1700 W TOWNLINE ST
Mailing Address - Street 2:
Mailing Address - City:CRESTON
Mailing Address - State:IA
Mailing Address - Zip Code:50801-1054
Mailing Address - Country:US
Mailing Address - Phone:641-782-1181
Mailing Address - Fax:
Practice Address - Street 1:1700 W TOWNLINE ST
Practice Address - Street 2:
Practice Address - City:CRESTON
Practice Address - State:IA
Practice Address - Zip Code:50801-1054
Practice Address - Country:US
Practice Address - Phone:641-782-1181
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-06
Last Update Date:2024-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA172781207RG0100X, 363LF0000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1639880065Medicaid
IA2022068325OtherSPECIALITY
IA2022068325Medicaid