Provider Demographics
NPI:1609571157
Name:HORTEN, RYAN TYLER
Entity Type:Individual
Prefix:
First Name:RYAN
Middle Name:TYLER
Last Name:HORTEN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3980 OAKS CLUBHOUSE DR APT 409
Mailing Address - Street 2:
Mailing Address - City:POMPANO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33069-3683
Mailing Address - Country:US
Mailing Address - Phone:954-258-9052
Mailing Address - Fax:
Practice Address - Street 1:670 GLADES RD STE 200
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33431-6464
Practice Address - Country:US
Practice Address - Phone:561-495-9511
Practice Address - Fax:561-990-7426
Is Sole Proprietor?:No
Enumeration Date:2023-04-04
Last Update Date:2023-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9117216363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant