Provider Demographics
NPI:1811487622
Name:HOFFMANN, JACOB KEITH (PA-C)
Entity type:Individual
Prefix:MR
First Name:JACOB
Middle Name:KEITH
Last Name:HOFFMANN
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6322 S 3000 E STE 140
Mailing Address - Street 2:
Mailing Address - City:COTTONWOOD HEIGHTS
Mailing Address - State:UT
Mailing Address - Zip Code:84121-3555
Mailing Address - Country:US
Mailing Address - Phone:801-733-9924
Mailing Address - Fax:
Practice Address - Street 1:6322 S 3000 E STE 140
Practice Address - Street 2:
Practice Address - City:COTTONWOOD HEIGHTS
Practice Address - State:UT
Practice Address - Zip Code:84121-3555
Practice Address - Country:US
Practice Address - Phone:801-733-9924
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-16
Last Update Date:2018-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT10818363-1206363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant