Healthcare Provider Details

I. General information

NPI: 1528694114
Provider Name (Legal Business Name): MARIA MARMAROU HORNBERGER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/16/2020
Last Update Date: 05/28/2026
Certification Date: 05/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

307 BOATNER RD
EGLIN AFB FL
32542-1302
US

IV. Provider business mailing address

307 BOATNER RD
EGLIN AFB FL
32542-1302
US

V. Phone/Fax

Practice location:
  • Phone: 850-883-8600
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number33805
License Number StateNE
# 2
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number33805
License Number StateNE
# 3
Primary TaxonomyN
Taxonomy Code2083A0100X
TaxonomyAerospace Medicine Physician
License Number33805
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: