Healthcare Provider Details

I. General information

NPI: 1285622829
Provider Name (Legal Business Name): JOHN A HORN PA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/07/2005
Last Update Date: 05/12/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 DIXIE HWY
LEESBURG FL
34748
US

IV. Provider business mailing address

13748 CALLE DE ORA CT
CLERMONT FL
34711-7276
US

V. Phone/Fax

Practice location:
  • Phone: 352-323-5762
  • Fax:
Mailing address:
  • Phone: 352-394-0822
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA0002200
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: