Provider Demographics
NPI:1376363044
Name:HORTON, TANYA NICOLE (REGISTERED NURSE)
Entity type:Individual
Prefix:MRS
First Name:TANYA
Middle Name:NICOLE
Last Name:HORTON
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:86 HOOKER RD
Mailing Address - Street 2:
Mailing Address - City:SILVER CREEK
Mailing Address - State:MS
Mailing Address - Zip Code:39663-4320
Mailing Address - Country:US
Mailing Address - Phone:601-596-7301
Mailing Address - Fax:
Practice Address - Street 1:141 A JEFFERSON STREET
Practice Address - Street 2:
Practice Address - City:MONTICELLO
Practice Address - State:MS
Practice Address - Zip Code:39654
Practice Address - Country:US
Practice Address - Phone:769-600-2221
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-16
Last Update Date:2024-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker