Provider Demographics
NPI:1851017685
Name:HORNE, DONNICA
Entity Type:Individual
Prefix:
First Name:DONNICA
Middle Name:
Last Name:HORNE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:DONNICA
Other - Middle Name:
Other - Last Name:MASON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:732 E 45TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11203-5720
Mailing Address - Country:US
Mailing Address - Phone:718-809-2742
Mailing Address - Fax:
Practice Address - Street 1:999 BLAKE AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11208-3535
Practice Address - Country:US
Practice Address - Phone:718-277-8303
Practice Address - Fax:718-277-4795
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-13
Last Update Date:2024-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF348279363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty