Basic Information
| Provider Information | |||||||||
| NPI: | 1245722586 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HORIN | ||||||||
| FirstName: | CAROLYN | ||||||||
| MiddleName: | |||||||||
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| Credential: | FNP-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2401 VALLEY DR | ||||||||
| Address2: | |||||||||
| City: | VALPARAISO | ||||||||
| State: | IN | ||||||||
| PostalCode: | 463832520 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2194135100 | ||||||||
| FaxNumber: | 2194629502 | ||||||||
| Practice Location | |||||||||
| Address1: | 621 MEMORIAL DR STE 402 | ||||||||
| Address2: | |||||||||
| City: | SOUTH BEND | ||||||||
| State: | IN | ||||||||
| PostalCode: | 466011074 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5744004550 | ||||||||
| FaxNumber: | 5744004551 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/02/2018 | ||||||||
| LastUpdateDate: | 05/07/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 05/07/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | F02180133 | IL | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | 363LF0000X | 71008338A | IN | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
ID Information
| ID | Type | State | Issuer | Description | 300019356 | 05 | IN | MEDICAID |