Provider Demographics
NPI:1952497950
Name:HORNBACK, JENNIFER K (MD)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:K
Last Name:HORNBACK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7111 S VIRGINIA ST
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89511-1115
Mailing Address - Country:US
Mailing Address - Phone:775-851-5700
Mailing Address - Fax:775-851-5710
Practice Address - Street 1:7111 S VIRGINIA ST
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89511-1115
Practice Address - Country:US
Practice Address - Phone:775-851-5700
Practice Address - Fax:775-851-5710
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2021-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV9964207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV2016901Medicaid
NV2016901Medicaid
NVH37157Medicare UPIN