Provider Demographics
NPI:1841556669
Name:HORNER, SALLY B (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:
First Name:SALLY
Middle Name:B
Last Name:HORNER
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1064 GOODLETTE RD N
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34102-5449
Mailing Address - Country:US
Mailing Address - Phone:239-649-1186
Mailing Address - Fax:
Practice Address - Street 1:1064 GOODLETTE RD N
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34102-5449
Practice Address - Country:US
Practice Address - Phone:239-649-1186
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-04-05
Last Update Date:2012-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP2096082363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLE6062ZMedicare UPIN