Provider Demographics
NPI:1831156751
Name:HORNE, FREDA GALE (LIC AC)
Entity type:Individual
Prefix:MRS
First Name:FREDA
Middle Name:GALE
Last Name:HORNE
Suffix:
Gender:F
Credentials:LIC AC
Other - Prefix:MRS
Other - First Name:SUKI
Other - Middle Name:GALE
Other - Last Name:HORNE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LIC AC
Mailing Address - Street 1:1260 CEDAR CENTER DR
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32301-4876
Mailing Address - Country:US
Mailing Address - Phone:850-219-9777
Mailing Address - Fax:
Practice Address - Street 1:1260 CEDAR CENTER DR
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32301-4876
Practice Address - Country:US
Practice Address - Phone:850-219-9777
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP1310171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist