Provider Demographics
NPI:1528245966
Name:HOFFMAN, BRENDA M (PA-C)
Entity type:Individual
Prefix:MRS
First Name:BRENDA
Middle Name:M
Last Name:HOFFMAN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:3702 NEW VISION DR BLDG B
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46845-1703
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:13430 MAIN ST
Practice Address - Street 2:
Practice Address - City:GRABILL
Practice Address - State:IN
Practice Address - Zip Code:46741-2001
Practice Address - Country:US
Practice Address - Phone:260-469-6604
Practice Address - Fax:260-969-3070
Is Sole Proprietor?:No
Enumeration Date:2008-01-29
Last Update Date:2020-05-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IN10000276363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
INS70951Medicare UPIN