Provider Demographics
NPI:1467456418
Name:HORTON, TINA M (PA-C)
Entity Type:Individual
Prefix:MS
First Name:TINA
Middle Name:M
Last Name:HORTON
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:2121 W CHANDLER BLVD
Mailing Address - Street 2:SUITE 110
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85224
Mailing Address - Country:US
Mailing Address - Phone:480-963-2233
Mailing Address - Fax:480-963-2277
Practice Address - Street 1:2121 W CHANDLER BLVD
Practice Address - Street 2:SUITE 110
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85224-6545
Practice Address - Country:US
Practice Address - Phone:480-963-2233
Practice Address - Fax:480-963-2277
Is Sole Proprietor?:No
Enumeration Date:2005-06-08
Last Update Date:2011-12-16
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
AZ2767363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZAZ0146780OtherBCBS
AZ880858Medicaid
AZAZ0146780OtherBCBS
AZ880858Medicaid