MEDICARE: JESSICA M HORLACHER FNP

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	363LF0000X	Family Nurse Practitioner	20579	SC

General Provider Information

NPI Number	:	1114469665
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSICA M HORLACHER FNP

Provider Business Mailing Address
First Line	:	378 JUNIPER BEND CIR
Second Line	:
City	:	GREENVILLE
State	:	SC
Zip	:	29615-6229
Country	:	US
Telephone Number	:	864-420-2548
Fax Number	:

Provider Business Practice Location Address
First Line	:	3101 S HIGHWAY 14
Second Line	:
City	:	GREENVILLE
State	:	SC
Zip	:	29615-5950
Country	:	US
Telephone Number	:	864-520-1121
Fax Number	:

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

Provider Enumeration Date	:	11/15/2016
Last Update Date	:	08/18/2021

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