MEDICARE: HORIZON FAMILY MEDICINE LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner

General Provider Information

NPI Number	:	1942944582
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HORIZON FAMILY MEDICINE LLC

Provider Business Mailing Address
First Line	:	477 CONNECTICUT BLVD STE 119
Second Line	:
City	:	EAST HARTFORD
State	:	CT
Zip	:	06108-3228
Country	:	US
Telephone Number	:	860-216-9976
Fax Number	:

Provider Business Practice Location Address
First Line	:	477 CONNECTICUT BLVD STE 119
Second Line	:
City	:	EAST HARTFORD
State	:	CT
Zip	:	06108-3228
Country	:	US
Telephone Number	:	475-320-8111
Fax Number	:

Authorized Official
Title or Position	:	APRN
Name	:	STEPHANIE PETTINGLE
Credential	:	DNP, FNP-C, APRN
Telephone Number	:	860-216-9976

Provider Enumeration Date	:	04/20/2022
Last Update Date	:	12/17/2022

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