Provider Demographics
NPI:1912605221
Name:HOFFMAN, LARISSA L (APRN)
Entity Type:Individual
Prefix:
First Name:LARISSA
Middle Name:L
Last Name:HOFFMAN
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:LARISSA
Other - Middle Name:L
Other - Last Name:HORNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSN, APRN
Mailing Address - Street 1:PO BOX 538
Mailing Address - Street 2:
Mailing Address - City:TECUMSEH
Mailing Address - State:NE
Mailing Address - Zip Code:68450-0538
Mailing Address - Country:US
Mailing Address - Phone:402-335-2811
Mailing Address - Fax:
Practice Address - Street 1:202 HIGH ST
Practice Address - Street 2:
Practice Address - City:TECUMSEH
Practice Address - State:NE
Practice Address - Zip Code:68450-2443
Practice Address - Country:US
Practice Address - Phone:402-335-2811
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-16
Last Update Date:2024-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS118269163W00000X
KS161591363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse