MEDICARE: LESLIE SUZANN HORNE PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363AM0700X	Medical Physician Assistant	PA9103683	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	PA9103683	OTHER	FL	FLORIDA LICENSE
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1013093384
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LESLIE SUZANN HORNE PA-C

Provider Business Mailing Address
First Line	:	705 WELLS RD STE 300
Second Line	:
City	:	ORANGE PARK
State	:	FL
Zip	:	32073-2982
Country	:	US
Telephone Number	:	904-282-6331
Fax Number	:	904-619-1080

Provider Business Practice Location Address
First Line	:	2700 RIVERSIDE AVE STE 2
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32205-8233
Country	:	US
Telephone Number	:	904-265-7020
Fax Number	:	904-621-0566

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/30/2006
Last Update Date	:	08/30/2022

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