Healthcare Provider Details

I. General information

NPI: 1588599229
Provider Name (Legal Business Name): COURTNEY R HORNILLA RN, IBCLC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2026
Last Update Date: 06/15/2026
Certification Date: 06/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1104 TWIN RIVERS DR
CHARLESTON SC
29492-8812
US

IV. Provider business mailing address

9615 E COUNTY LINE RD STE B
CENTENNIAL CO
80112-3531
US

V. Phone/Fax

Practice location:
  • Phone: 407-406-2585
  • Fax:
Mailing address:
  • Phone: 888-991-6772
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License NumberL-319070
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: