Provider Demographics
NPI:1194116020
Name:HORN, LAURA (ARNP)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:HORN
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9030 W FORT ISLAND TRL STE 10A
Mailing Address - Street 2:
Mailing Address - City:CRYSTAL RIVER
Mailing Address - State:FL
Mailing Address - Zip Code:34429-8001
Mailing Address - Country:US
Mailing Address - Phone:352-563-2597
Mailing Address - Fax:352-563-2836
Practice Address - Street 1:9030 W FORT ISLAND TRL STE 10A
Practice Address - Street 2:
Practice Address - City:CRYSTAL RIVER
Practice Address - State:FL
Practice Address - Zip Code:34429-8001
Practice Address - Country:US
Practice Address - Phone:352-563-2597
Practice Address - Fax:352-563-2836
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-13
Last Update Date:2015-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP 1012162363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLIC158ZMedicare UPIN