Provider Demographics
NPI:1841230752
Name:HOFFMAN, JENNIFER S (CNP)
Entity type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:S
Last Name:HOFFMAN
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 190930
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83719-0930
Mailing Address - Country:US
Mailing Address - Phone:208-367-5170
Mailing Address - Fax:208-367-5180
Practice Address - Street 1:3325 POCAHONTAS RD
Practice Address - Street 2:
Practice Address - City:BAKER CITY
Practice Address - State:OR
Practice Address - Zip Code:97814-1464
Practice Address - Country:US
Practice Address - Phone:541-524-8000
Practice Address - Fax:541-524-7955
Is Sole Proprietor?:No
Enumeration Date:2006-06-08
Last Update Date:2024-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209-000531363LF0000X
OR202100030NP-PP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL05732097OtherBC GROUP NUMBER
IL101038OtherHEALTH ALLIANCE
IL101038OtherHEALTH ALLIANCE
Q36152Medicare UPIN
K23124Medicare ID - Type Unspecified
IL212636Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER