Provider Demographics
NPI:1609956994
Name:HORTON, NANCY A (DMD)
Entity type:Individual
Prefix:DR
First Name:NANCY
Middle Name:A
Last Name:HORTON
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3617 W SWANN AVE
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33609-4517
Mailing Address - Country:US
Mailing Address - Phone:813-879-9299
Mailing Address - Fax:813-879-8035
Practice Address - Street 1:3617 W SWANN AVE
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33609-4517
Practice Address - Country:US
Practice Address - Phone:813-879-9299
Practice Address - Fax:813-879-8035
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-17
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL123271223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL12327OtherLICENSE#
FLBN5512719OtherDEA NUMBER