Provider Demographics
NPI:1083503551
Name:HORN, ANTHONY AUSTIN BACTOL
Entity type:Individual
Prefix:
First Name:ANTHONY AUSTIN
Middle Name:BACTOL
Last Name:HORN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3901 DURANT CT W
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28412-7447
Mailing Address - Country:US
Mailing Address - Phone:510-520-5717
Mailing Address - Fax:
Practice Address - Street 1:3901 DURANT CT W
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28412-7447
Practice Address - Country:US
Practice Address - Phone:510-520-5717
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-30
Last Update Date:2025-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHORN-8C8DB363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily