Provider Demographics
NPI:1912900267
Name:HOFMANN, TALIA ANN (PA-C)
Entity Type:Individual
Prefix:
First Name:TALIA
Middle Name:ANN
Last Name:HOFMANN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8550 W 38TH AVE
Mailing Address - Street 2:STE 202
Mailing Address - City:WHEAT RIDGE
Mailing Address - State:CO
Mailing Address - Zip Code:80033-4342
Mailing Address - Country:US
Mailing Address - Phone:303-940-1661
Mailing Address - Fax:303-431-8708
Practice Address - Street 1:8550 W 38TH AVE
Practice Address - Street 2:STE 202
Practice Address - City:WHEAT RIDGE
Practice Address - State:CO
Practice Address - Zip Code:80033-4342
Practice Address - Country:US
Practice Address - Phone:303-940-1661
Practice Address - Fax:303-431-8708
Is Sole Proprietor?:No
Enumeration Date:2005-05-31
Last Update Date:2014-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPA1284363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
COP48953Medicare UPIN
C452478Medicare ID - Type Unspecified