Healthcare Provider Details

I. General information

NPI: 1053550889
Provider Name (Legal Business Name): ANGEL LYN HORNER ACUPUNCTURE PHYS.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/18/2009
Last Update Date: 03/18/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 POMPANO RD
ST AUGUSTINE FL
32086-5718
US

IV. Provider business mailing address

100 POMPANO RD
ST AUGUSTINE FL
32086-5718
US

V. Phone/Fax

Practice location:
  • Phone: 904-797-6501
  • Fax:
Mailing address:
  • Phone: 904-797-6501
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAP2650
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: