Provider Demographics
NPI:1033963665
Name:VAN HORN, JENNIFER (DT, MS HS)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:VAN HORN
Suffix:
Gender:F
Credentials:DT, MS HS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:113 MAGNOLIA WAY
Mailing Address - Street 2:
Mailing Address - City:TEQUESTA
Mailing Address - State:FL
Mailing Address - Zip Code:33469-2113
Mailing Address - Country:US
Mailing Address - Phone:757-647-1004
Mailing Address - Fax:
Practice Address - Street 1:113 MAGNOLIA WAY
Practice Address - Street 2:
Practice Address - City:TEQUESTA
Practice Address - State:FL
Practice Address - Zip Code:33469-2113
Practice Address - Country:US
Practice Address - Phone:757-647-1004
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-11
Last Update Date:2024-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education