Basic Information
| Provider Information | |||||||||
| NPI: | 1215305628 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HOFFMAN | ||||||||
| FirstName: | NICOLE | ||||||||
| MiddleName: | LEE | ||||||||
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| Credential: | PA-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 10 NORTH DR | ||||||||
| Address2: | |||||||||
| City: | TABERNACLE | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 080888657 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6097606092 | ||||||||
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| Practice Location | |||||||||
| Address1: | 10800 KNIGHTS RD | ||||||||
| Address2: | |||||||||
| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 191144200 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2156124963 | ||||||||
| FaxNumber: | 2156124532 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/02/2015 | ||||||||
| LastUpdateDate: | 08/05/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | OA003610 | PA | N | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | 363A00000X | MA057776 | PA | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
No ID Information.