Provider Demographics
NPI:1083835334
Name:HORNAK, ANGELA J (ANP-BC,FNP-BC,DNP)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:J
Last Name:HORNAK
Suffix:
Gender:F
Credentials:ANP-BC,FNP-BC,DNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 REID PKWY
Mailing Address - Street 2:MEDICAL STAFF SERVICES
Mailing Address - City:RICHMOND
Mailing Address - State:IN
Mailing Address - Zip Code:47374-1157
Mailing Address - Country:US
Mailing Address - Phone:765-983-3217
Mailing Address - Fax:765-983-3219
Practice Address - Street 1:1350 CHESTER BLVD STE B
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:IN
Practice Address - Zip Code:47374-1962
Practice Address - Country:US
Practice Address - Phone:765-935-4088
Practice Address - Fax:765-966-2596
Is Sole Proprietor?:No
Enumeration Date:2007-05-02
Last Update Date:2021-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71001941A363LF0000X, 363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
000000681778OtherANTHEM
IN200996510Medicaid
OH0067475Medicaid
INM400027317Medicare PIN