MEDICARE: SARAH LOUISE STORNIOLO NURSE PRACTITIONER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	237887	TN
2	163W00000X	Registered Nurse	201700591RN	OR
3	363LF0000X	Family Nurse Practitioner	202009555NP-PP	OR
4	363LF0000X	Family Nurse Practitioner	95032524	CA

General Provider Information

NPI Number	:	1215554068
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SARAH LOUISE STORNIOLO NURSE PRACTITIONER

Provider Business Mailing Address
First Line	:	4000 HOLLYWOOD BLVD STE 215S
Second Line	:
City	:	HOLLYWOOD
State	:	FL
Zip	:	33021-1227
Country	:	US
Telephone Number	:	310-659-9075
Fax Number	:	310-689-2422

Provider Business Practice Location Address
First Line	:	8631 W 3RD ST STE 1035
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90048-5964
Country	:	US
Telephone Number	:	310-659-9075
Fax Number	:	310-689-2422

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/28/2020
Last Update Date	:	04/21/2026

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