Provider Demographics
NPI:1316528466
Name:HOFMANN, NATHAN (APRN FNP-BC)
Entity type:Individual
Prefix:
First Name:NATHAN
Middle Name:
Last Name:HOFMANN
Suffix:
Gender:M
Credentials:APRN FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3082 MCMURRAY DR
Mailing Address - Street 2:
Mailing Address - City:ANDERSON
Mailing Address - State:CA
Mailing Address - Zip Code:96007-3544
Mailing Address - Country:US
Mailing Address - Phone:530-365-4412
Mailing Address - Fax:530-365-5186
Practice Address - Street 1:3082 MCMURRAY DR
Practice Address - Street 2:
Practice Address - City:ANDERSON
Practice Address - State:CA
Practice Address - Zip Code:96007-3544
Practice Address - Country:US
Practice Address - Phone:530-365-4412
Practice Address - Fax:530-365-5186
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-20
Last Update Date:2024-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.0028775363LF0000X
CA95031289207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHAPRN.CNP.0028775Medicaid