Healthcare Provider Details

I. General information

NPI: 1982993408
Provider Name (Legal Business Name): THOMAS JEROME HORAN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/05/2011
Last Update Date: 08/05/2026
Certification Date: 08/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4750 N FEDERAL HWY STE 202
FORT LAUDERDALE FL
33308-4609
US

IV. Provider business mailing address

2608 NE 33RD ST
FORT LAUDERDALE FL
33306-1516
US

V. Phone/Fax

Practice location:
  • Phone: 800-457-4573
  • Fax: 800-443-6422
Mailing address:
  • Phone: 305-796-2269
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPC005807L
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPY7424
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: