Healthcare Provider Details

I. General information

NPI: 1245722586
Provider Name (Legal Business Name): CAROLYN HORIN FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/02/2018
Last Update Date: 05/07/2020
Certification Date: 05/07/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

621 MEMORIAL DR STE 402
SOUTH BEND IN
46601-1074
US

IV. Provider business mailing address

2401 VALLEY DR
VALPARAISO IN
46383-2520
US

V. Phone/Fax

Practice location:
  • Phone: 574-400-4550
  • Fax: 574-400-4551
Mailing address:
  • Phone: 219-413-5100
  • Fax: 219-462-9502

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberF02180133
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number71008338A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: