Provider Demographics
NPI:1114906948
Name:HORAN, PATRICE MARY (NP)
Entity Type:Individual
Prefix:MS
First Name:PATRICE
Middle Name:MARY
Last Name:HORAN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:231 RAYMOND RD
Mailing Address - Street 2:
Mailing Address - City:WEST HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06107-2539
Mailing Address - Country:US
Mailing Address - Phone:860-301-3132
Mailing Address - Fax:
Practice Address - Street 1:30 JORDAN LANE
Practice Address - Street 2:PRIME HEALTHCARE
Practice Address - City:WETHERSFIELD
Practice Address - State:CT
Practice Address - Zip Code:06109
Practice Address - Country:US
Practice Address - Phone:860-263-0263
Practice Address - Fax:860-263-0567
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-11
Last Update Date:2021-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000508363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004236007Medicaid
CT000508OtherAPRN
CT03145972OtherAPRN
CT03145972OtherAPRN