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General NPI Number Information
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NPI Number | 1013088194
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Entity Type | Individual
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Provider Name | GLEN ROLAND HORNE CRNA
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Gender | Male
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Dates
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Enumeration Date | 11/13/2006
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Last Update Date | 11/04/2024
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Provider Practice Location Address
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Address Line | 2525 DESALES AVE
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City | CHATTANOOGA
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State | TN
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Zip | 37404-1161
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Country | US
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Telephone | 423-206-5040
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Fax |
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Provider Business Mailing Address
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Address Line | 5 CALHOUN AVE UNIT 606
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City | DESTIN
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State | FL
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Zip | 32541-5509
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Country | US
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Telephone | 404-310-6048
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Fax | 404-255-1831
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | 110691
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | 9397267
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License Number State | FL
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