Provider Demographics
NPI:1508139023
Name:HORNBACK, IRYNA (FNP-C)
Entity type:Individual
Prefix:
First Name:IRYNA
Middle Name:
Last Name:HORNBACK
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:IRYNA
Other - Middle Name:
Other - Last Name:CRIBLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP-C
Mailing Address - Street 1:10140 191ST ST
Mailing Address - Street 2:
Mailing Address - City:MOKENA
Mailing Address - State:IL
Mailing Address - Zip Code:60448-9381
Mailing Address - Country:US
Mailing Address - Phone:708-719-3527
Mailing Address - Fax:708-719-3520
Practice Address - Street 1:10140 191ST ST
Practice Address - Street 2:
Practice Address - City:MOKENA
Practice Address - State:IL
Practice Address - Zip Code:60448-9381
Practice Address - Country:US
Practice Address - Phone:708-719-3527
Practice Address - Fax:708-719-3520
Is Sole Proprietor?:No
Enumeration Date:2012-02-14
Last Update Date:2024-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCOA.18108-NP363LF0000X
IN28239908A363LF0000X
IL209.017053363LF0000X
PASP011970363LF0000X
IN71007715A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
ININ2920087OtherMEDICARE PTAN