Provider Demographics
NPI:1154866952
Name:VAN HORN, CHAD (PA-C)
Entity Type:Individual
Prefix:
First Name:CHAD
Middle Name:
Last Name:VAN HORN
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1970 S UNIVERSITY DR STE 25&26
Mailing Address - Street 2:
Mailing Address - City:DAVIE
Mailing Address - State:FL
Mailing Address - Zip Code:33324-5846
Mailing Address - Country:US
Mailing Address - Phone:954-864-4100
Mailing Address - Fax:
Practice Address - Street 1:1970 S UNIVERSITY DR STE 25&26
Practice Address - Street 2:
Practice Address - City:DAVIE
Practice Address - State:FL
Practice Address - Zip Code:33324-5846
Practice Address - Country:US
Practice Address - Phone:954-864-4100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-03
Last Update Date:2022-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPAT9110097363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant