Provider Demographics
NPI:1003936675
Name:HORST, CONNIE (RN, PHN)
Entity Type:Individual
Prefix:MS
First Name:CONNIE
Middle Name:
Last Name:HORST
Suffix:
Gender:F
Credentials:RN, PHN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1710 CANNAS CT
Mailing Address - Street 2:
Mailing Address - City:CARLSBAD
Mailing Address - State:CA
Mailing Address - Zip Code:92011
Mailing Address - Country:US
Mailing Address - Phone:760-804-9375
Mailing Address - Fax:
Practice Address - Street 1:1710 CANNAS CT
Practice Address - Street 2:
Practice Address - City:CARLSBAD
Practice Address - State:CA
Practice Address - Zip Code:92011-5103
Practice Address - Country:US
Practice Address - Phone:760-804-9375
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARN221847163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA163WC1500XOtherCOMMUNITY HEALTH