Healthcare Provider Details

I. General information

NPI: 1841760634
Provider Name (Legal Business Name): TIMOTHY HORINE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/05/2018
Last Update Date: 12/05/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

211 TELFORD PIKE
TELFORD PA
18969-2251
US

IV. Provider business mailing address

519 S 5TH ST STE 130
PERKASIE PA
18944-1061
US

V. Phone/Fax

Practice location:
  • Phone: 215-723-7833
  • Fax:
Mailing address:
  • Phone: 215-257-8601
  • Fax: 215-257-8619

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberSP019701
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: