Provider Demographics
NPI:1053905786
Name:HOFFMAN, LISA MARIE (APRN)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:MARIE
Last Name:HOFFMAN
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:153 4TH ST
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:65655-7418
Mailing Address - Country:US
Mailing Address - Phone:417-274-9117
Mailing Address - Fax:
Practice Address - Street 1:153 4TH ST
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:MO
Practice Address - Zip Code:65655-7418
Practice Address - Country:US
Practice Address - Phone:417-274-9117
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-23
Last Update Date:2021-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2020012828363LF0000X
AR214716363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily