Provider Demographics
NPI:1316517063
Name:HOFFMAN, SHANNON MARIE (FNP-BC)
Entity type:Individual
Prefix:
First Name:SHANNON
Middle Name:MARIE
Last Name:HOFFMAN
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:SHANNON
Other - Middle Name:MARIE
Other - Last Name:WALTERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP-BC
Mailing Address - Street 1:3115 AUDUBON DR
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MS
Mailing Address - Zip Code:39440-1913
Mailing Address - Country:US
Mailing Address - Phone:601-531-2200
Mailing Address - Fax:601-531-2220
Practice Address - Street 1:3115 AUDUBON DR
Practice Address - Street 2:
Practice Address - City:LAUREL
Practice Address - State:MS
Practice Address - Zip Code:39440-1913
Practice Address - Country:US
Practice Address - Phone:601-531-2200
Practice Address - Fax:601-531-2220
Is Sole Proprietor?:No
Enumeration Date:2021-06-25
Last Update Date:2021-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS904424363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily