Provider Demographics
NPI:1700551504
Name:HORTON, TIM WILLIAM (APRN, CNP)
Entity type:Individual
Prefix:
First Name:TIM
Middle Name:WILLIAM
Last Name:HORTON
Suffix:
Gender:M
Credentials:APRN, CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:652 BIELENBERG DR STE 202
Mailing Address - Street 2:
Mailing Address - City:WOODBURY
Mailing Address - State:MN
Mailing Address - Zip Code:55125-4480
Mailing Address - Country:US
Mailing Address - Phone:651-317-3902
Mailing Address - Fax:833-972-4801
Practice Address - Street 1:652 BIELENBERG DR STE 202
Practice Address - Street 2:
Practice Address - City:WOODBURY
Practice Address - State:MN
Practice Address - Zip Code:55125-4480
Practice Address - Country:US
Practice Address - Phone:651-317-3902
Practice Address - Fax:833-972-4801
Is Sole Proprietor?:No
Enumeration Date:2021-08-12
Last Update Date:2024-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN8321363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health