Provider Demographics
NPI:1881617629
Name:HOFMEISTER, JENNIFER L (PAC)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:L
Last Name:HOFMEISTER
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1627 E 18TH ST
Mailing Address - Street 2:
Mailing Address - City:LOVELAND
Mailing Address - State:CO
Mailing Address - Zip Code:80538-4209
Mailing Address - Country:US
Mailing Address - Phone:970-663-0135
Mailing Address - Fax:970-461-1422
Practice Address - Street 1:1900 BOISE AVE
Practice Address - Street 2:SUITE 410
Practice Address - City:LOVELAND
Practice Address - State:CO
Practice Address - Zip Code:80538-5004
Practice Address - Country:US
Practice Address - Phone:970-667-2009
Practice Address - Fax:970-667-2103
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2009-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2274363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO26782782Medicaid
COCO305659Medicare PIN
COQ71859Medicare UPIN
CO26782782Medicaid