Provider Demographics
NPI:1538351705
Name:HOFFMAN, TAWNYA IRENE (PA-C)
Entity type:Individual
Prefix:
First Name:TAWNYA
Middle Name:IRENE
Last Name:HOFFMAN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:TAWNYA
Other - Middle Name:IRENE
Other - Last Name:MORRIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:10470 OLD PLACERVILLE RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95827-2539
Mailing Address - Country:US
Mailing Address - Phone:800-470-0071
Mailing Address - Fax:
Practice Address - Street 1:16911 WILLOW GLEN ROAD
Practice Address - Street 2:
Practice Address - City:BROWNSVILLE
Practice Address - State:CA
Practice Address - Zip Code:95919-0609
Practice Address - Country:US
Practice Address - Phone:530-675-0466
Practice Address - Fax:530-675-0530
Is Sole Proprietor?:No
Enumeration Date:2007-08-13
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA19295363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
P00776482OtherRAILROAD MEDICARE
P00776482OtherRAILROAD MEDICARE
CACJ036ZMedicare PIN
CA0PA192952Medicare PIN
CAMM1626689OtherDEA
CJ036ZMedicare PIN