Healthcare Provider Details

I. General information

NPI: 1578603452
Provider Name (Legal Business Name): JENNIFER TAWN HORTON PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/08/2007
Last Update Date: 02/23/2023
Certification Date: 02/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3210 E HURON RD
AU GRES MI
48703-9322
US

IV. Provider business mailing address

PO BOX 779
TAWAS CITY MI
48764-0779
US

V. Phone/Fax

Practice location:
  • Phone: 989-876-7104
  • Fax: 989-876-2881
Mailing address:
  • Phone: 989-876-7104
  • Fax: 989-876-2881

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number5601002327
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: