Provider Demographics
NPI:1154436426
Name:HOFFMANN, AMY (NP)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:HOFFMANN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3210 N MOUNTAIN VIEW DR
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83704-4635
Mailing Address - Country:US
Mailing Address - Phone:208-376-4612
Mailing Address - Fax:
Practice Address - Street 1:3210 N MOUNTAIN VIEW DR
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83704-4635
Practice Address - Country:US
Practice Address - Phone:208-376-4612
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-20
Last Update Date:2011-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDNP 356-A363LP2300X
IDNP356-A363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO57335061Medicaid
CO57335061Medicaid
506748Medicare ID - Type Unspecified