Provider Demographics
NPI:1063749372
Name:HOFFMASTER, JENNIFER A (PA-C)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:A
Last Name:HOFFMASTER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:A
Other - Last Name:WAGNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:137 JPM ROAD
Mailing Address - Street 2:
Mailing Address - City:LEWISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17837-9313
Mailing Address - Country:US
Mailing Address - Phone:570-523-3937
Mailing Address - Fax:570-524-5279
Practice Address - Street 1:137 JPM ROAD
Practice Address - Street 2:
Practice Address - City:LEWISBURG
Practice Address - State:PA
Practice Address - Zip Code:17837-9313
Practice Address - Country:US
Practice Address - Phone:570-523-3937
Practice Address - Fax:570-524-5279
Is Sole Proprietor?:No
Enumeration Date:2009-11-06
Last Update Date:2011-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA054203363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
169398E3FMedicare PIN