Provider Demographics
NPI:1073991337
Name:HORNAK, TRACEY LEE
Entity Type:Individual
Prefix:
First Name:TRACEY
Middle Name:LEE
Last Name:HORNAK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:TRACEY
Other - Middle Name:L
Other - Last Name:HORNAK
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHDHP
Mailing Address - Street 1:159 HECKMAN CEMETERY RD
Mailing Address - Street 2:
Mailing Address - City:SPRING MILLS
Mailing Address - State:PA
Mailing Address - Zip Code:16875-8316
Mailing Address - Country:US
Mailing Address - Phone:814-880-3190
Mailing Address - Fax:
Practice Address - Street 1:6830 TONER CAMP ROAD
Practice Address - Street 2:
Practice Address - City:HUNTINGDON
Practice Address - State:PA
Practice Address - Zip Code:16652
Practice Address - Country:US
Practice Address - Phone:814-667-3547
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-05-07
Last Update Date:2015-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPHDH000548124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist