1033729546 NPI number — ANDERSON HEALTHCARE MASTERS LLC

Table of content: DR. AUDRA CHERI HORNEY PH.D. (NPI 1801322862)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1033729546 NPI number — ANDERSON HEALTHCARE MASTERS LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ANDERSON HEALTHCARE MASTERS LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1033729546
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/04/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7643 GATE PKWY STE 104-523
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
JACKSONVILLE
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32256-3092
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:
904-253-3492

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3390 KORI RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
JACKSONVILLE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32257-2419
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
904-638-3511
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/10/2020

Additional Information

Authorized Official

Authorized Official Last Name:
ANDERSON
Authorized Official First Name:
TANISHA
Authorized Official Middle Name:
Authorized Official Title or Position:
APRN
Authorized Official Telephone Number:
904-909-1227

Provider Taxonomy Codes

  • Taxonomy code: 363LP2300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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