Provider Demographics
NPI:1942944582
Name:HORIZON FAMILY MEDICINE LLC
Entity Type:Organization
Organization Name:HORIZON FAMILY MEDICINE LLC
Other - Org Name:HORIZON FAMILY MEDICINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:APRN
Authorized Official - Prefix:
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:PETTINGLE
Authorized Official - Suffix:
Authorized Official - Credentials:DNP, FNP-C, APRN
Authorized Official - Phone:860-216-9976
Mailing Address - Street 1:477 CONNECTICUT BLVD STE 119
Mailing Address - Street 2:
Mailing Address - City:EAST HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06108-3228
Mailing Address - Country:US
Mailing Address - Phone:860-216-9976
Mailing Address - Fax:
Practice Address - Street 1:477 CONNECTICUT BLVD STE 119
Practice Address - Street 2:
Practice Address - City:EAST HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06108-3228
Practice Address - Country:US
Practice Address - Phone:475-320-8111
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-20
Last Update Date:2022-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty