Basic Information
Provider Information
NPI: 1174775928
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: HOFFMAN
FirstName: TRICIA
MiddleName:  
NamePrefix: MS.
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 6020
Address2:  
City: RAPID CITY
State: SD
PostalCode: 577096020
CountryCode: US
TelephoneNumber: 6053423280
FaxNumber: 6057218438
Practice Location
Address1: 717 SAINT FRANCIS STREET
Address2:  
City: RAPID CITY
State: SD
PostalCode: 57701
CountryCode: US
TelephoneNumber: 6053422880
FaxNumber: 6053884617
Other Information
ProviderEnumerationDate: 10/10/2008
LastUpdateDate: 12/01/2016
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363A00000X0695SDY Physician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant 

No ID Information.


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