Provider Demographics
NPI:1972742260
Name:HORNBERGER, TINA MARLENE (LDN)
Entity Type:Individual
Prefix:
First Name:TINA
Middle Name:MARLENE
Last Name:HORNBERGER
Suffix:
Gender:F
Credentials:LDN
Other - Prefix:
Other - First Name:TINA
Other - Middle Name:
Other - Last Name:YOST
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:409 S 2ND ST STE 2F
Mailing Address - Street 2:
Mailing Address - City:HARRISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17104-1612
Mailing Address - Country:US
Mailing Address - Phone:717-231-8937
Mailing Address - Fax:717-231-8588
Practice Address - Street 1:101 WASHINGTON ST
Practice Address - Street 2:LEARNING INSTITUTE
Practice Address - City:HARRISBURG
Practice Address - State:PA
Practice Address - Zip Code:17104-1675
Practice Address - Country:US
Practice Address - Phone:717-221-6258
Practice Address - Fax:717-221-6266
Is Sole Proprietor?:No
Enumeration Date:2009-02-11
Last Update Date:2017-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADN003273133N00000X, 133V00000X
PA926114136A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No133N00000XDietary & Nutritional Service ProvidersNutritionist
No136A00000XDietary & Nutritional Service ProvidersDietetic Technician, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA102257169Medicaid