Provider Demographics
NPI:1053550889
Name:HORNER, ANGEL LYN (ACUPUNCTURE PHYS)
Entity type:Individual
Prefix:MRS
First Name:ANGEL
Middle Name:LYN
Last Name:HORNER
Suffix:
Gender:F
Credentials:ACUPUNCTURE PHYS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 POMPANO RD
Mailing Address - Street 2:
Mailing Address - City:ST AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32086-5718
Mailing Address - Country:US
Mailing Address - Phone:904-797-6501
Mailing Address - Fax:
Practice Address - Street 1:100 POMPANO RD
Practice Address - Street 2:
Practice Address - City:ST AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32086-5718
Practice Address - Country:US
Practice Address - Phone:904-797-6501
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-18
Last Update Date:2009-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP2650171100000X
225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist