Healthcare Provider Details

I. General information

NPI: 1356431951
Provider Name (Legal Business Name): KATHLEEN ANN HORN CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/13/2006
Last Update Date: 10/05/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3880 TAMIAMI TRL N
NAPLES FL
34103-3504
US

IV. Provider business mailing address

3880 TAMIAMI TRL N
NAPLES FL
34103-3504
US

V. Phone/Fax

Practice location:
  • Phone: 239-659-3937
  • Fax:
Mailing address:
  • Phone: 239-659-3937
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberARNP 9166690
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: