Provider Demographics
NPI:1396745337
Name:HORLICK, NANCY (MD)
Entity type:Individual
Prefix:
First Name:NANCY
Middle Name:
Last Name:HORLICK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26224 N TATUM BLVD
Mailing Address - Street 2:SUITE 1
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85050-7500
Mailing Address - Country:US
Mailing Address - Phone:480-563-1111
Mailing Address - Fax:480-563-3044
Practice Address - Street 1:26224 N TATUM BLVD
Practice Address - Street 2:SUITE 1
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85050-7500
Practice Address - Country:US
Practice Address - Phone:480-563-1111
Practice Address - Fax:480-563-3044
Is Sole Proprietor?:No
Enumeration Date:2005-07-29
Last Update Date:2008-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ27067208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
5225829OtherCCN
AZ2Z1962OtherHEALTH NET
12-00497OtherUNITED HEALTHCARE
1229050OtherFIRST HEALTH
210610OtherMAYO
AZ45380304Medicaid
54847745OtherAETNA
AZAZ0770330OtherBLUE CROSS
1229050OtherFIRST HEALTH