Provider Demographics
NPI:1427606367
Name:HORLBECK, ANNA GRACE (PA-C)
Entity type:Individual
Prefix:
First Name:ANNA
Middle Name:GRACE
Last Name:HORLBECK
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:ANNA
Other - Middle Name:GRACE
Other - Last Name:LEICHTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:3050 MACK RD STE 200
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:45014-5375
Mailing Address - Country:US
Mailing Address - Phone:513-347-9999
Mailing Address - Fax:513-215-9397
Practice Address - Street 1:3050 MACK RD STE 200
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:OH
Practice Address - Zip Code:45014-5375
Practice Address - Country:US
Practice Address - Phone:513-347-9999
Practice Address - Fax:513-215-9397
Is Sole Proprietor?:No
Enumeration Date:2019-09-03
Last Update Date:2024-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH50.007533RX363A00000X
FL9111836363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant